Provider Demographics
NPI:1730969569
Name:FLICK, ZACHARY SHANE
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:SHANE
Last Name:FLICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8527 UNIVERSITY BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-1069
Mailing Address - Country:US
Mailing Address - Phone:515-710-7141
Mailing Address - Fax:
Practice Address - Street 1:8527 UNIVERSITY BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1069
Practice Address - Country:US
Practice Address - Phone:515-710-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist