Healthcare Provider Details

I. General information

NPI: 1003884131
Provider Name (Legal Business Name): PETER THOMAS ZOGRAFOS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 E ALKI AVE
SPOKANE VALLEY WA
99212-2705
US

IV. Provider business mailing address

8921 E ALKI AVE
SPOKANE VALLEY WA
99212-2705
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-5100
  • Fax: 509-928-1651
Mailing address:
  • Phone: 509-928-5100
  • Fax: 509-928-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00001073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: