Provider Demographics
NPI:1356432819
Name:ZAYCOSKY, CARL (DC)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:ZAYCOSKY
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 1:168 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2239
Mailing Address - Country:US
Mailing Address - Phone:937-382-3466
Mailing Address - Fax:937-382-8899
Practice Address - Street 1:168 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2239
Practice Address - Country:US
Practice Address - Phone:937-382-3466
Practice Address - Fax:937-382-8899
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU-27104Medicare UPIN
OHZA0630631Medicare ID - Type Unspecified