Provider Demographics
NPI:1366741084
Name:MARK A ZITNIK DC, LLC
Entity type:Organization
Organization Name:MARK A ZITNIK DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZITNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-888-6675
Mailing Address - Street 1:1916 N PENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2697
Mailing Address - Country:US
Mailing Address - Phone:480-888-6675
Mailing Address - Fax:
Practice Address - Street 1:5233 E SOUTHERN AVE
Practice Address - Street 2:#104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3625
Practice Address - Country:US
Practice Address - Phone:480-830-2882
Practice Address - Fax:480-830-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7770111N00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty