Healthcare Provider Details

I. General information

NPI: 1306182407
Provider Name (Legal Business Name): ZANDI CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 TABLE MESA DR SUITE 201
BOULDER CO
80305-5869
US

IV. Provider business mailing address

3400 TABLE MESA DR SUITE 201
BOULDER CO
80305-5869
US

V. Phone/Fax

Practice location:
  • Phone: 518-593-5583
  • Fax:
Mailing address:
  • Phone: 518-593-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6816
License Number StateCO

VIII. Authorized Official

Name: DR. SEPEHR ZANDI
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 518-593-5583