Healthcare Provider Details

I. General information

NPI: 1972903599
Provider Name (Legal Business Name): KENNETH ROGER ZOODSMA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BILL FRIES DRIVE SUITE C
HILTON HEAD SC
29926
US

IV. Provider business mailing address

7 HICKORY KNOLL PLACE
HILTON HEAD SC
29926
US

V. Phone/Fax

Practice location:
  • Phone: 843-338-2894
  • Fax:
Mailing address:
  • Phone: 843-338-2894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3887
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR005027
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: