Provider Demographics
NPI:1568529592
Name:MAZYAR NESHAT, D.C., P.A.
Entity Type:Organization
Organization Name:MAZYAR NESHAT, D.C., P.A.
Other - Org Name:MAZ CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZYAR
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NESHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-882-2255
Mailing Address - Street 1:1001 VAN BUREN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5584
Mailing Address - Country:US
Mailing Address - Phone:704-882-2255
Mailing Address - Fax:704-882-2252
Practice Address - Street 1:1001 VAN BUREN AVE STE E
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5584
Practice Address - Country:US
Practice Address - Phone:704-882-2255
Practice Address - Fax:704-882-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2976111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085EAOtherBCBS
NC5901819Medicaid
NC618261OtherUHC
NC618261OtherUHC
NC=========Medicare ID - Type Unspecified