Healthcare Provider Details

I. General information

NPI: 1457898694
Provider Name (Legal Business Name): JAMES CHRISTIAN ZOTTI LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 W BURLINGTON AVE SUITE 104
LA GRANGE IL
60525-2221
US

IV. Provider business mailing address

512 W BURLINGTON AVE SUITE 104
LA GRANGE IL
60525-2221
US

V. Phone/Fax

Practice location:
  • Phone: 708-469-7592
  • Fax: 708-469-7897
Mailing address:
  • Phone: 708-469-7592
  • Fax: 708-469-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.001357
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: