Healthcare Provider Details

I. General information

NPI: 1689727778
Provider Name (Legal Business Name): CARROLLE ANN ZVONAR D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11494 BRINK AVE
CHISAGO CITY MN
55013-9411
US

IV. Provider business mailing address

31864 QUINLAN AVE
CENTER CITY MN
55012-7636
US

V. Phone/Fax

Practice location:
  • Phone: 651-257-3914
  • Fax: 651-257-3915
Mailing address:
  • Phone: 651-307-7524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number002174
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: