Healthcare Provider Details

I. General information

NPI: 1891186995
Provider Name (Legal Business Name): JOHN ZUGZDA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4898 FICKLE HILL RD
ARCATA CA
95521-9010
US

IV. Provider business mailing address

4898 FICKLE HILL RD
ARCATA CA
95521-9010
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-4000
  • Fax:
Mailing address:
  • Phone: 707-822-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number25955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: