Provider Demographics
NPI:1386712545
Name:CHIROPRACTIC AND SPORTS INJURY CENTER OF JACKSON HOLE PC
Entity type:Organization
Organization Name:CHIROPRACTIC AND SPORTS INJURY CENTER OF JACKSON HOLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ZENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-733-8088
Mailing Address - Street 1:PO BOX 10039
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-0039
Mailing Address - Country:US
Mailing Address - Phone:307-733-8088
Mailing Address - Fax:307-734-8584
Practice Address - Street 1:215 SCOTT LANE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-733-8088
Practice Address - Fax:307-734-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW303891Medicare ID - Type Unspecified
T32752Medicare UPIN