Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC25398 | CA |
NPI | 1124031679 |
---|---|
Provider Name | Charles Zollner |
First Address | Mill Valley, CA 94941-3488 |
Second Address | San Rafael, CA 94903-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U71683 | (02) |