Provider Demographics
NPI:1275581993
Name:ZOZZARO, JOHN L JR (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:ZOZZARO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1713 FORT JESSE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6235
Mailing Address - Country:US
Mailing Address - Phone:309-862-2225
Mailing Address - Fax:309-862-2229
Practice Address - Street 1:1713 FORT JESSE RD
Practice Address - Street 2:SUITE D
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6208
Practice Address - Country:US
Practice Address - Phone:309-862-2225
Practice Address - Fax:309-862-2229
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL094634OtherHEALTH ALLIANCE
IL5732064OtherBLUE CROSS BLUE SHIELD
IL002334074002OtherUNITED HEALTH CARE
IL209791Medicare ID - Type Unspecified