Healthcare Provider Details

I. General information

NPI: 1316215593
Provider Name (Legal Business Name): ZACHARY NOLAN ZUGSCHWERDT D.C., CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 11/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 5TH AVE N STE A
SEATTLE WA
98109-4241
US

IV. Provider business mailing address

621 5TH AVE N STE A
SEATTLE WA
98109-5316
US

V. Phone/Fax

Practice location:
  • Phone: 206-858-6667
  • Fax: 206-607-9957
Mailing address:
  • Phone: 206-858-6667
  • Fax: 206-607-9957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number32019
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH 60271312
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: