Provider Demographics
NPI:1700598679
Name:EDELMAN, ZACKARY KRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACKARY
Middle Name:KRAIG
Last Name:EDELMAN
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 1:24540 230TH ST
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-6762
Mailing Address - Country:US
Mailing Address - Phone:405-826-0583
Mailing Address - Fax:
Practice Address - Street 1:9101 S WESTERN AVE STE 112
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2757
Practice Address - Country:US
Practice Address - Phone:405-735-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor