Healthcare Provider Details

I. General information

NPI: 1003448689
Provider Name (Legal Business Name): ZACHARY ALAN JASKINIA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 SWITZER ST
SHAWNEE KS
66203-4550
US

IV. Provider business mailing address

7410 SWITZER ST
SHAWNEE KS
66203-4550
US

V. Phone/Fax

Practice location:
  • Phone: 913-962-7408
  • Fax: 913-962-7416
Mailing address:
  • Phone: 913-962-7408
  • Fax: 913-962-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-06031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: