Provider Demographics
NPI:1841909900
Name:ZEN CHIROPRACTIC & WELLNESS SPACE
Entity type:Organization
Organization Name:ZEN CHIROPRACTIC & WELLNESS SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-263-1004
Mailing Address - Street 1:6414 PARK HEIGHTS AVE STE G1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3064
Mailing Address - Country:US
Mailing Address - Phone:410-307-4774
Mailing Address - Fax:
Practice Address - Street 1:6414 PARK HEIGHTS AVE STE G1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3064
Practice Address - Country:US
Practice Address - Phone:410-307-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty