MEDICARE: MR. JOHN L. ZOZZARO JR. D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	094634	OTHER	IL	HEALTH ALLIANCE
2	5732064	OTHER	IL	BLUE CROSS BLUE SHIELD
3	002334074002	OTHER	IL	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1275581993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN L. ZOZZARO JR. D.C.

Provider Business Mailing Address
First Line	:	1713 FORT JESSE RD
Second Line	:	SUITE D
City	:	NORMAL
State	:	IL
Zip	:	61761-6235
Country	:	US
Telephone Number	:	309-862-2225
Fax Number	:	309-862-2229

Provider Business Practice Location Address
First Line	:	1713 FORT JESSE RD
Second Line	:	SUITE D
City	:	NORMAL
State	:	IL
Zip	:	61761-6208
Country	:	US
Telephone Number	:	309-862-2225
Fax Number	:	309-862-2229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JOHN L. ZOZZARO JR. D.C.” Practice Location

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