Provider Demographics
NPI:1104216670
Name:MAZZEO, ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:MAZZEO
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 1:14319 ADDISON ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1848
Mailing Address - Country:US
Mailing Address - Phone:818-456-3318
Mailing Address - Fax:
Practice Address - Street 1:14319 ADDISON ST UNIT 1
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1848
Practice Address - Country:US
Practice Address - Phone:818-456-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor