Provider Demographics
NPI:1740217165
Name:MAZION, JUDITH LOUISE (DC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LOUISE
Last Name:MAZION
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 1:105 TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:SOMONAUK
Mailing Address - State:IL
Mailing Address - Zip Code:60552-9700
Mailing Address - Country:US
Mailing Address - Phone:815-498-2308
Mailing Address - Fax:
Practice Address - Street 1:105 TERRACE CT
Practice Address - Street 2:
Practice Address - City:SOMONAUK
Practice Address - State:IL
Practice Address - Zip Code:60552-9700
Practice Address - Country:US
Practice Address - Phone:815-498-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2383111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01915187OtherBCBS
IL640440Medicare PIN