Provider Demographics
NPI:1659469781
Name:MAZZA, CARMEN ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ANN
Last Name:MAZZA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 N BORNITE WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-9749
Mailing Address - Country:US
Mailing Address - Phone:609-864-2399
Mailing Address - Fax:
Practice Address - Street 1:4620 N BORNITE WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-9749
Practice Address - Country:US
Practice Address - Phone:609-864-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00618200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223603289OtherTAX ID NUMBER
NJ223603289OtherTAX ID NUMBER