Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 01-06031 | KS |
NPI | 1003448689 |
---|---|
Provider Name | Zachary Alan Jaskinia |
First Address | Shawnee, KS 66203-4550 |
Second Address | Shawnee, KS 66203-4550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2020 |
Last Update Date | 11/02/2020 |