Healthcare Provider Details

I. General information

NPI: 1710294772
Provider Name (Legal Business Name): JOSH MICHAEL ZUMSTEIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18141 DIXIE HWY SUITE 107
HOMEWOOD IL
60430-2238
US

IV. Provider business mailing address

18141 DIXIE HWY SUITE 107
HOMEWOOD IL
60430-2238
US

V. Phone/Fax

Practice location:
  • Phone: 708-365-6353
  • Fax: 708-365-6563
Mailing address:
  • Phone: 708-365-6353
  • Fax: 708-365-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011679
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: