Provider Demographics
NPI:1912461872
Name:HOMER, ZACHARY RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:RICHARD
Last Name:HOMER
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 1:1166 E WARNER RD STE 101C
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3065
Mailing Address - Country:US
Mailing Address - Phone:480-339-7142
Mailing Address - Fax:
Practice Address - Street 1:1166 E WARNER RD STE 101C
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3065
Practice Address - Country:US
Practice Address - Phone:480-339-7142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor