Healthcare Provider Details

I. General information

NPI: 1629007935
Provider Name (Legal Business Name): RANDY R ZOLMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 G ST SE
QUINCY WA
98848-1556
US

IV. Provider business mailing address

210 G ST SE
QUINCY WA
98848-1556
US

V. Phone/Fax

Practice location:
  • Phone: 509-787-1918
  • Fax:
Mailing address:
  • Phone: 509-787-1918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00002703
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: