Healthcare Provider Details

I. General information

NPI: 1093012692
Provider Name (Legal Business Name): DANIEL P ZAGST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N MAIN ST
MOORESVILLE NC
28115-2312
US

IV. Provider business mailing address

162 SARDIS RD
MOORESVILLE NC
28115-7961
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-3455
  • Fax: 704-664-2827
Mailing address:
  • Phone: 716-912-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4232
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: