Provider Demographics
NPI:1881051019
Name:BOCKMAN, ZACHARY (LAC)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:BOCKMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:510 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-3618
Mailing Address - Country:US
Mailing Address - Phone:707-595-0215
Mailing Address - Fax:707-640-2099
Practice Address - Street 1:1179 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-559-7500
Practice Address - Fax:707-559-7620
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16749171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist