Healthcare Provider Details

I. General information

NPI: 1184089963
Provider Name (Legal Business Name): ZETOCHA CHIROPRACTIC & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 9TH AVE N
CASSELTON ND
58012-3339
US

IV. Provider business mailing address

PO BOX 833
CASSELTON ND
58012-0833
US

V. Phone/Fax

Practice location:
  • Phone: 701-346-0116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1019
License Number StateND

VIII. Authorized Official

Name: DR. ANDREW J ZETOCHA
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 701-710-0639