Provider Demographics
NPI:1538230149
Name:ZITLAW, GREGORY GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GEORGE
Last Name:ZITLAW
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:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-1349
Mailing Address - Country:US
Mailing Address - Phone:530-934-4291
Mailing Address - Fax:530-934-7811
Practice Address - Street 1:130 N BUTTE ST
Practice Address - Street 2:STE J
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2836
Practice Address - Country:US
Practice Address - Phone:530-934-4291
Practice Address - Fax:530-934-7811
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU31377Medicare UPIN
CADC0193400Medicare ID - Type UnspecifiedMEDICARE