Provider Demographics
NPI:1740656982
Name:ZERAVICH, JOHN (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:ZERAVICH
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1605
Mailing Address - Country:US
Mailing Address - Phone:415-246-5867
Mailing Address - Fax:
Practice Address - Street 1:336 ELLEN DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1605
Practice Address - Country:US
Practice Address - Phone:415-246-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor