Provider Demographics
NPI:1366519217
Name:ZILLIOX, JOHN NUGENT (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NUGENT
Last Name:ZILLIOX
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:NUGENT
Other - Last Name:ZILLIOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3316 SHERIDAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1439
Mailing Address - Country:US
Mailing Address - Phone:716-833-1664
Mailing Address - Fax:716-836-7418
Practice Address - Street 1:3316 SHERIDAN DRIVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1439
Practice Address - Country:US
Practice Address - Phone:716-833-1664
Practice Address - Fax:716-836-7418
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0043181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
JZ006841Medicare ID - Type Unspecified