Provider Demographics
NPI:1578779716
Name:MAZUREK, TEDDY M (DC)
Entity Type:Individual
Prefix:DR
First Name:TEDDY
Middle Name:M
Last Name:MAZUREK
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 1:3616 NICOLLET AVE. S.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1235
Mailing Address - Country:US
Mailing Address - Phone:612-825-7390
Mailing Address - Fax:612-825-0772
Practice Address - Street 1:3616 NICOLLET AVE. S.
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1235
Practice Address - Country:US
Practice Address - Phone:612-825-7390
Practice Address - Fax:612-825-0772
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor