Provider Demographics
NPI:1720339617
Name:ZOBRIST, DOUGLAS ALLEN (DC, MPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:ZOBRIST
Suffix:
Gender:M
Credentials:DC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62563-9570
Mailing Address - Country:US
Mailing Address - Phone:217-498-1004
Mailing Address - Fax:217-498-1004
Practice Address - Street 1:128 JOHN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-9570
Practice Address - Country:US
Practice Address - Phone:217-498-1004
Practice Address - Fax:217-498-1004
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor