Healthcare Provider Details

I. General information

NPI: 1104281161
Provider Name (Legal Business Name): ZOAHWAY ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HIGHWAY 67 STE 204
DUNCANVILLE TX
75137-4481
US

IV. Provider business mailing address

PO BOX 2971
CEDAR HILL TX
75106-2971
US

V. Phone/Fax

Practice location:
  • Phone: 781-591-7472
  • Fax:
Mailing address:
  • Phone: 781-591-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number13079
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number13079
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number13079
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13079
License Number StateTX

VIII. Authorized Official

Name: COURTNEY LEVINGSTON
Title or Position: DIRECTOR
Credential:
Phone: 469-587-9614