Provider Demographics
NPI:1184743577
Name:FATKIN, ZACHARY DAVID (DC)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DAVID
Last Name:FATKIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-9766
Mailing Address - Country:US
Mailing Address - Phone:610-939-1474
Mailing Address - Fax:610-939-0780
Practice Address - Street 1:2421 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2957
Practice Address - Country:US
Practice Address - Phone:610-939-0780
Practice Address - Fax:610-939-0780
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007455L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034791OtherCAPITAL BLUE CROSS
7285770OtherAETNA
PAFA996411OtherHIGHMARK BLUE SHIELD
7285770OtherAETNA