Healthcare Provider Details

I. General information

NPI: 1588768063
Provider Name (Legal Business Name): BRANDON MICHAEL ZOLLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6213 SNIDER RD
MASON OH
45040-2643
US

IV. Provider business mailing address

3188 ELORA LN
HAMILTON OH
45011-0578
US

V. Phone/Fax

Practice location:
  • Phone: 513-754-0050
  • Fax: 513-229-3740
Mailing address:
  • Phone: 513-770-3434
  • Fax: 513-229-5432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3456
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: