Provider Demographics
NPI:1114035185
Name:NEJAD, MAZIAR A (DC)
Entity Type:Individual
Prefix:DR
First Name:MAZIAR
Middle Name:A
Last Name:NEJAD
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 1:336 CORNWALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1629
Mailing Address - Country:US
Mailing Address - Phone:440-221-6344
Mailing Address - Fax:
Practice Address - Street 1:4365 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-2133
Practice Address - Country:US
Practice Address - Phone:440-967-4226
Practice Address - Fax:440-967-0296
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2459236Medicaid
OH2459236Medicaid
OHNE4034622Medicare ID - Type Unspecified