Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 007735 | IA |
N | 111N00000X | Chiropractor | 038.012032 | IL |
N | 111NP0017X | Pediatric Chiropractor | 038.012032 | IL |
N | 111NR0400X | Rehabilitation Chiropractor | 038.012032 | IL |
NPI | 1922370444 |
---|---|
Provider Name | Dr. Zachary Robert Lujan |
First Address | Manchester, IA 52057-1522 |
Second Address | Manchester, IA 52057-1522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2012 |
Last Update Date | 07/03/2014 |