Healthcare Provider Details

I. General information

NPI: 1538230149
Provider Name (Legal Business Name): GREGORY GEORGE ZITLAW D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N BUTTE ST STE J
WILLOWS CA
95988-2836
US

IV. Provider business mailing address

PO BOX 1349
WILLOWS CA
95988-1349
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-4291
  • Fax: 530-934-7811
Mailing address:
  • Phone: 530-934-4291
  • Fax: 530-934-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number19340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: