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General NPI Number Information
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NPI Number | 1407143571
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Entity Type | Organization
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Legal Business Name | ZIDEK CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 522 W MAIN ST
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City | SHELBYVILLE
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State | IL
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Zip | 62565-1401
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Country | US
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Telephone | 217-774-4616
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Fax | 217-774-4844
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Provider Business Mailing Address
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Address Line | 522 W MAIN ST
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City | SHELBYVILLE
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State | IL
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Zip | 62565-1401
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Country | US
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Telephone | 217-774-4616
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Fax | 217-774-4844
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. RONALD JAMES ZIDEK
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Credential | D.C.
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Telephone | 217-774-4616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038010544
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038003467
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License Number State | IL
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