Provider Demographics
NPI:1235275074
Name:MAZZELLA, JOHN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:MAZZELLA
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 1:2397 STATE ROUTE 36
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2532
Mailing Address - Country:US
Mailing Address - Phone:732-872-6595
Mailing Address - Fax:732-872-1508
Practice Address - Street 1:2397 STATE ROUTE 36
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2532
Practice Address - Country:US
Practice Address - Phone:732-872-6595
Practice Address - Fax:732-872-1508
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMC04441OtherSTATE LICENSE NUMBER
NJMC04441OtherSTATE LICENSE NUMBER