Provider Demographics
NPI:1689709362
Name:SHIOZAWA, MARYANNE (DC)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:SHIOZAWA
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 1:146 CENTRAL PARK WEST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-877-1711
Mailing Address - Fax:212-877-1971
Practice Address - Street 1:146 CENTRAL PARK WEST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-877-1711
Practice Address - Fax:212-877-1971
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX9130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNYX9130Medicare UPIN