Healthcare Provider Details

I. General information

NPI: 1114395209
Provider Name (Legal Business Name): MR. ZACH JOHN SCHAFFNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 CLARK AVE
ALLIANCE OH
44601-3929
US

IV. Provider business mailing address

9894 GEORGETOWN ST
LOUISVILLE OH
44641-9676
US

V. Phone/Fax

Practice location:
  • Phone: 330-265-1532
  • Fax:
Mailing address:
  • Phone: 330-265-1532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: