Provider Demographics
NPI:1730218892
Name:ZAJAC, ANN (DC LCAC DIPLAC)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:ZAJAC
Suffix:
Gender:F
Credentials:DC LCAC DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17314 S OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3404
Mailing Address - Country:US
Mailing Address - Phone:708-614-1400
Mailing Address - Fax:708-614-1426
Practice Address - Street 1:17314 S OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3404
Practice Address - Country:US
Practice Address - Phone:708-614-1400
Practice Address - Fax:708-614-1426
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001617968OtherBLUE CROSS BLUE SHIELD
IL0001617968OtherBLUE CROSS BLUE SHIELD
T396006Medicare UPIN