Healthcare Provider Details

I. General information

NPI: 1104803238
Provider Name (Legal Business Name): ANN ZUKAUSKAS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 09/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 SW SCHOLLS FERRY RD STE 205
PORTLAND OR
97225-1692
US

IV. Provider business mailing address

2421 SE BARNES RD
GRESHAM OR
97080-7276
US

V. Phone/Fax

Practice location:
  • Phone: 503-663-9319
  • Fax:
Mailing address:
  • Phone: 503-663-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number27 3158
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: