Provider Demographics
NPI:1063970473
Name:VANDERWEIDE, ZACHARY AUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:AUSTIN
Last Name:VANDERWEIDE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 SPAULDING HILLS CIR SE APT 205
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7885
Mailing Address - Country:US
Mailing Address - Phone:616-540-7467
Mailing Address - Fax:
Practice Address - Street 1:2855 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-2415
Practice Address - Country:US
Practice Address - Phone:616-532-2518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor