Provider Demographics
NPI:1982254512
Name:BISSANI, ZAKARI LARBI (DC)
Entity Type:Individual
Prefix:DR
First Name:ZAKARI
Middle Name:LARBI
Last Name:BISSANI
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 1:12139 MOUNT VERNON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5519
Mailing Address - Country:US
Mailing Address - Phone:720-989-0890
Mailing Address - Fax:
Practice Address - Street 1:12139 MOUNT VERNON AVE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5519
Practice Address - Country:US
Practice Address - Phone:720-989-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.008059111N00000X
CA34858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8746840562OtherNATIONAL REGISTRY OF CERTIFIED MEDICAL EXAMINERS