Healthcare Provider Details

I. General information

NPI: 1124031679
Provider Name (Legal Business Name): CHARLES ZOLLNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/12/2024
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4380 REDWOOD HWY STE B6
SAN RAFAEL CA
94903-2110
US

IV. Provider business mailing address

4380 REDWOOD HWY STE B6
SAN RAFAEL CA
94903-2110
US

V. Phone/Fax

Practice location:
  • Phone: 415-747-8980
  • Fax: 415-499-8645
Mailing address:
  • Phone: 415-747-8980
  • Fax: 415-499-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC25398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: