Provider Demographics
NPI:1053171835
Name:DECARLO, ZACAHRY JR (DC)
Entity type:Individual
Prefix:DR
First Name:ZACAHRY
Middle Name:
Last Name:DECARLO
Suffix:JR
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 1:101 E 8TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1783
Mailing Address - Country:US
Mailing Address - Phone:610-567-8011
Mailing Address - Fax:
Practice Address - Street 1:101 E 8TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1783
Practice Address - Country:US
Practice Address - Phone:610-567-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor