Provider Demographics
NPI:1265871776
Name:ZWIENER, MICHAEL RYAN (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:ZWIENER
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 1:672 GRAVOIS BLUFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7714
Mailing Address - Country:US
Mailing Address - Phone:636-326-2525
Mailing Address - Fax:
Practice Address - Street 1:672 GRAVOIS BLUFFS BLVD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7714
Practice Address - Country:US
Practice Address - Phone:636-326-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013013135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor