Provider Demographics
NPI:1184089963
Name:ZETOCHA CHIROPRACTIC & REHAB
Entity type:Organization
Organization Name:ZETOCHA CHIROPRACTIC & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZETOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-710-0639
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:CASSELTON
Mailing Address - State:ND
Mailing Address - Zip Code:58012-0833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 9TH AVE N
Practice Address - Street 2:
Practice Address - City:CASSELTON
Practice Address - State:ND
Practice Address - Zip Code:58012-3339
Practice Address - Country:US
Practice Address - Phone:701-346-0116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty