Provider Demographics
NPI:1912162041
Name:ZOLLER, BRENT MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:MICHAEL
Last Name:ZOLLER
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 1:9641 FOXHOUND DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5572
Mailing Address - Country:US
Mailing Address - Phone:937-239-4044
Mailing Address - Fax:
Practice Address - Street 1:8241 CORNELL RD
Practice Address - Street 2:SUITE #200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2283
Practice Address - Country:US
Practice Address - Phone:513-777-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor