Provider Demographics
NPI:1689446387
Name:DEMING, ZACHARIAH
Entity type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:
Last Name:DEMING
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 1:355 US HIGHWAY 93 N STE C
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-9059
Mailing Address - Country:US
Mailing Address - Phone:720-204-0828
Mailing Address - Fax:
Practice Address - Street 1:355 US HIGHWAY 93 N STE C
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9059
Practice Address - Country:US
Practice Address - Phone:720-204-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT29182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty