Basic Information
Provider Information | |||||||||
NPI: | 1972010668 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ZENITH CHIROPRACTIC PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1969 | ||||||||
Address2: |   | ||||||||
City: | FRISCO | ||||||||
State: | TX | ||||||||
PostalCode: | 750340034 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8172670102 | ||||||||
FaxNumber: | 8887706360 | ||||||||
Practice Location | |||||||||
Address1: | 800 FOREST OAKS LN STE C | ||||||||
Address2: |   | ||||||||
City: | HURST | ||||||||
State: | TX | ||||||||
PostalCode: | 760534959 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8172670102 | ||||||||
FaxNumber: | 8887706360 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/04/2018 | ||||||||
LastUpdateDate: | 06/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GILL | ||||||||
AuthorizedOfficialFirstName: | GURSIMRAN | ||||||||
AuthorizedOfficialMiddleName: | SINGH | ||||||||
AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
AuthorizedOfficialTelephone: | 4692362132 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 13012 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |   |
No ID Information.