Provider Demographics
NPI:1679633275
Name:MAZZARELLA, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MAZZARELLA
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 1:30 RAVENSCROFT DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3611
Mailing Address - Country:US
Mailing Address - Phone:828-254-1767
Mailing Address - Fax:828-254-1772
Practice Address - Street 1:30 RAVENSCROFT DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3611
Practice Address - Country:US
Practice Address - Phone:828-254-1767
Practice Address - Fax:828-254-1772
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3007111N00000X
NC3891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor