1689727778 NPI number — DR. CARROLLE ANN ZVONAR D.C.

Table of content: DR. CARROLLE ANN ZVONAR D.C. (NPI 1689727778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689727778 NPI number — DR. CARROLLE ANN ZVONAR D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZVONAR
Provider First Name:
CARROLLE
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689727778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31864 QUINLAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTER CITY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55012-7636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-307-7524
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11494 BRINK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHISAGO CITY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55013-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-257-3914
Provider Business Practice Location Address Fax Number:
651-257-3915
Provider Enumeration Date:
01/19/2007

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: 111NN1001X , with the licence number:  002174 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 52P45ZV . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 668226000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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