Provider Demographics
NPI:1982762324
Name:ZDILLA, MICHAEL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:ZDILLA
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 1:1179 ROSTRAVER RD
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4504
Mailing Address - Country:US
Mailing Address - Phone:724-929-6777
Mailing Address - Fax:888-221-7407
Practice Address - Street 1:1179 ROSTRAVER RD
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-4504
Practice Address - Country:US
Practice Address - Phone:724-929-6777
Practice Address - Fax:888-221-7407
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAZD1575591OtherBLUE CROSS
PA1575591OtherBLUE CROSS