Provider Demographics
NPI:1023107661
Name:ZINNEN-NOWAK, JODI LEE (DC)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:LEE
Last Name:ZINNEN-NOWAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9701
Mailing Address - Country:US
Mailing Address - Phone:734-241-4500
Mailing Address - Fax:734-241-4602
Practice Address - Street 1:2100 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9701
Practice Address - Country:US
Practice Address - Phone:734-241-4500
Practice Address - Fax:734-241-4602
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4815050Medicaid
950E810830OtherBCBS
U59120Medicare UPIN
0P14450Medicare ID - Type Unspecified