Provider Demographics
NPI:1467643676
Name:MAZZIOTTI, FRANK HARRISON SR (DC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:HARRISON
Last Name:MAZZIOTTI
Suffix:SR
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 1:130 NORTH WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2263
Mailing Address - Country:US
Mailing Address - Phone:928-684-7733
Mailing Address - Fax:
Practice Address - Street 1:130 NORTH WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2263
Practice Address - Country:US
Practice Address - Phone:928-684-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T41924Medicare UPIN
Z26501Medicare PIN