Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2254 | MN |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2254 | MN |
NPI | 1194808162 |
---|---|
Provider Name | Dr. Zachary John Zachman |
First Address | Minneapolis, MN 55431-1602 |
Second Address | Minneapolis, MN 55431-1602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T85004 | (02) | MN |