Healthcare Provider Details

I. General information

NPI: 1831117936
Provider Name (Legal Business Name): ZOOK CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 JOHN SIMS PKWY E
NICEVILLE FL
32578-2204
US

IV. Provider business mailing address

1148 E. JOHN SIMS PKWY
NICEVILLE FL
32578
US

V. Phone/Fax

Practice location:
  • Phone: 850-678-4155
  • Fax: 850-678-1855
Mailing address:
  • Phone: 850-678-4155
  • Fax: 850-678-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0006149
License Number StateFL

VIII. Authorized Official

Name: DR. TIMOTHY L. ZOOK
Title or Position: OWNER
Credential: D.C.
Phone: 850-678-4155