MEDICARE: MISS JACKIE ZAIC M.T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist		MN

General Provider Information

NPI Number	:	1346542602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JACKIE ZAIC M.T

Provider Business Mailing Address
First Line	:	2720 E 50TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-1337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 E 50TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-1337
Country	:	US
Telephone Number	:	612-721-0036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	11/18/2010

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