Provider Demographics
NPI:1104803238
Name:ZUKAUSKAS, ANN (DC)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:ZUKAUSKAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 SE BARNES RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7276
Mailing Address - Country:US
Mailing Address - Phone:503-663-9319
Mailing Address - Fax:
Practice Address - Street 1:4850 SW SCHOLLS FERRY RD STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1692
Practice Address - Country:US
Practice Address - Phone:503-663-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3158111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition