Healthcare Provider Details

I. General information

NPI: 1356104905
Provider Name (Legal Business Name): DERIK ZIRAKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E COLORADO ST STE 560
GLENDALE CA
91205-1627
US

IV. Provider business mailing address

425 E COLORADO ST STE 560
GLENDALE CA
91205-1627
US

V. Phone/Fax

Practice location:
  • Phone: 747-297-4799
  • Fax: 747-297-4837
Mailing address:
  • Phone: 747-297-4799
  • Fax: 747-297-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: