Provider Demographics
NPI:1447718036
Name:ZELLWEGER FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:ZELLWEGER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ZELLWEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-706-2378
Mailing Address - Street 1:1 MALLETT WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6066
Mailing Address - Country:US
Mailing Address - Phone:843-706-2378
Mailing Address - Fax:843-706-2178
Practice Address - Street 1:1017 US HIGHWAY 80 E STE 17
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9533
Practice Address - Country:US
Practice Address - Phone:912-748-9125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZELLWEGER FAMILY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty