Healthcare Provider Details

I. General information

NPI: 1245706811
Provider Name (Legal Business Name): ZACHARY AARON KOTLERMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GREENLEAF AVE
BURLINGTON WA
98233-2017
US

IV. Provider business mailing address

1100 GREENLEAF AVE
BURLINGTON WA
98233-2017
US

V. Phone/Fax

Practice location:
  • Phone: 310-663-5265
  • Fax:
Mailing address:
  • Phone: 310-663-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number60894940
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: