Provider Demographics
NPI:1437540945
Name:MAZZUCHELLI, MARK (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MAZZUCHELLI
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 1:38 POND ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3807
Mailing Address - Country:US
Mailing Address - Phone:508-528-7015
Mailing Address - Fax:
Practice Address - Street 1:38 POND ST
Practice Address - Street 2:SUITE 206
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3807
Practice Address - Country:US
Practice Address - Phone:508-528-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor