Healthcare Provider Details

I. General information

NPI: 1982042123
Provider Name (Legal Business Name): ZAVACKI CHIROPRACTIC HEALTH MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 CAMINO DEL RIO S SUITE 120
SAN DIEGO CA
92108-3509
US

IV. Provider business mailing address

438 CAMINO DEL RIO S SUITE 120
SAN DIEGO CA
92108-3509
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-2773
  • Fax: 619-295-3825
Mailing address:
  • Phone: 619-272-2773
  • Fax: 619-295-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number22221
License Number StateCA

VIII. Authorized Official

Name: PETE ZAVACKI
Title or Position: OWNER, CLINIC DIRECTOR
Credential: D.C.
Phone: 619-272-2773