Healthcare Provider Details

I. General information

NPI: 1447235544
Provider Name (Legal Business Name): DEREK ZID D.C., CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 W NORTH AVE SUITE 307
MELROSE PARK IL
60160-1422
US

IV. Provider business mailing address

1440 W NORTH AVE SUITE 307
MELROSE PARK IL
60160-1422
US

V. Phone/Fax

Practice location:
  • Phone: 708-345-1299
  • Fax:
Mailing address:
  • Phone: 708-345-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008863
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: