Provider Demographics
NPI:1285819276
Name:PETE ZAVACKI CHIROPRACTIC, INC
Entity type:Organization
Organization Name:PETE ZAVACKI CHIROPRACTIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVACKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-370-2181
Mailing Address - Street 1:75 S SAN TOMAS AQUINO RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2575
Mailing Address - Country:US
Mailing Address - Phone:408-370-2181
Mailing Address - Fax:408-370-2088
Practice Address - Street 1:75 S SAN TOMAS AQUINO RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2575
Practice Address - Country:US
Practice Address - Phone:408-370-2181
Practice Address - Fax:408-370-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0222210Medicare UPIN