Provider Demographics
NPI:1588768063
Name:ZOLLER, BRANDON MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:ZOLLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3188 ELORA LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-0578
Mailing Address - Country:US
Mailing Address - Phone:513-770-3434
Mailing Address - Fax:513-229-5432
Practice Address - Street 1:6213 SNIDER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2643
Practice Address - Country:US
Practice Address - Phone:513-754-0050
Practice Address - Fax:513-229-3740
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000520322OtherANTHEM
OH250757Medicaid
OH000000520322OtherANTHEM