Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4873-12 | WI |
NPI | 1063779312 |
---|---|
Provider Name | Dr. Zachary Landon |
First Address | Reedsburg, WI 53959-1972 |
Second Address | Reedsburg, WI 53959-1972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 09/01/2019 |