Healthcare Provider Details

I. General information

NPI: 1447426358
Provider Name (Legal Business Name): ZOLMAN CHIROPRACTIC CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
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: 509-787-3140
Mailing address:
  • Phone: 509-787-1918
  • Fax: 509-787-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number602024651
License Number StateWA

VIII. Authorized Official

Name: DR. RANDY R ZOLMAN
Title or Position: MEMBER/MANAGER
Credential: DC
Phone: 509-787-1918