1891011094 NPI number — DR. SHELBY NICOLE ZACKAROFF D.C., M.S.

Table of content: DR. SHELBY NICOLE ZACKAROFF D.C., M.S. (NPI 1891011094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891011094 NPI number — DR. SHELBY NICOLE ZACKAROFF D.C., M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZACKAROFF
Provider First Name:
SHELBY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VOJTECH ZACKAROFF
Provider Other First Name:
SHELBY
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C., M.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1891011094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8900 DARROW RD
Provider Second Line Business Mailing Address:
SUITE H104
Provider Business Mailing Address City Name:
TWINSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44087-6800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-963-2273
Provider Business Mailing Address Fax Number:
330-963-2275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8900 DARROW RD
Provider Second Line Business Practice Location Address:
SUITE H104
Provider Business Practice Location Address City Name:
TWINSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44087-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-963-2273
Provider Business Practice Location Address Fax Number:
330-963-2275
Provider Enumeration Date:
04/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4045 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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