Provider Demographics
NPI:1760492409
Name:ZANK, DAVID A (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ZANK
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 1:147 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2513
Mailing Address - Country:US
Mailing Address - Phone:309-649-1200
Mailing Address - Fax:309-649-1203
Practice Address - Street 1:147 W ELM ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2513
Practice Address - Country:US
Practice Address - Phone:309-649-1200
Practice Address - Fax:309-649-1203
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94795Medicare UPIN
20-5448Medicare ID - Type Unspecified