Provider Demographics
NPI:1538360888
Name:ZAMORA, JAY DANIEL (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:DANIEL
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607
Mailing Address - Country:US
Mailing Address - Phone:520-364-6463
Mailing Address - Fax:520-364-6503
Practice Address - Street 1:1915 E 10TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607
Practice Address - Country:US
Practice Address - Phone:520-364-6463
Practice Address - Fax:520-364-6503
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0559171100000X
AZ7867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist