Healthcare Provider Details

I. General information

NPI: 1851716658
Provider Name (Legal Business Name): AMMON ZUKERAN D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 ALPINE TRAIL LN SUITE 109
KATY TX
77494-3184
US

IV. Provider business mailing address

6326 ALPINE TRAIL LN SUITE 109
KATY TX
77494-3184
US

V. Phone/Fax

Practice location:
  • Phone: 808-658-0257
  • Fax: 808-658-0257
Mailing address:
  • Phone: 808-658-0257
  • Fax: 808-658-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC1270
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: