MEDICARE: DR. CHRISTOPHER ROBERT ZELEZ DC

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	DC007512L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2E112180	OTHER	PA	BCBC

General Provider Information

NPI Number	:	1710997358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER ROBERT ZELEZ DC

Provider Business Mailing Address
First Line	:	7738 FERNDALE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111
Country	:	US
Telephone Number	:	215-342-6222
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 S 3RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-2814
Country	:	US
Telephone Number	:	215-928-9171
Fax Number	:	215-928-9172

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	12/29/2010

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