Provider Demographics
NPI:1386282408
Name:ZAMZOW, DIANA K (LAC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:ZAMZOW
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:ZAMZOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:115 CLEGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-8401
Mailing Address - Country:US
Mailing Address - Phone:828-625-2727
Mailing Address - Fax:
Practice Address - Street 1:2753 LYNN RD STE C
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-6856
Practice Address - Country:US
Practice Address - Phone:828-625-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC249171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty