Provider Demographics
NPI:1699553982
Name:CHICKACHOP, ZACHARY (DC)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:CHICKACHOP
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 1:205 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5521
Mailing Address - Country:US
Mailing Address - Phone:727-223-9970
Mailing Address - Fax:727-491-5623
Practice Address - Street 1:205 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5521
Practice Address - Country:US
Practice Address - Phone:272-239-9707
Practice Address - Fax:727-491-5623
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011051111N00000X
FLCH14913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor