Healthcare Provider Details

I. General information

NPI: 1669837431
Provider Name (Legal Business Name): ANDREW ZETOCHA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
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

2417 DEMORES DR S APT 6
FARGO ND
58103-3757
US

V. Phone/Fax

Practice location:
  • Phone: 701-710-0639
  • Fax:
Mailing address:
  • Phone: 701-710-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: