MEDICARE: ZASTROW CHIROPRACTIC OFFICE, LLC

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	111NN1001X	Nutrition Chiropractor	1813-12	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457751778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZASTROW CHIROPRACTIC OFFICE, LLC

Provider Business Mailing Address
First Line	:	1624 E MASON ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-2739
Country	:	US
Telephone Number	:	920-465-0400
Fax Number	:	920-465-1430

Provider Business Practice Location Address
First Line	:	1624 E MASON ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-2739
Country	:	US
Telephone Number	:	920-465-0400
Fax Number	:	920-465-1430

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL LAWRENCE ZASTROW
Credential	:	D.C.
Telephone Number	:	920-465-0400

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	08/25/2014

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