Provider Demographics
NPI:1831497312
Name:SZLAZAK, MARK JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:SZLAZAK
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 1:170 N WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-5211
Mailing Address - Country:US
Mailing Address - Phone:408-548-7104
Mailing Address - Fax:408-404-8100
Practice Address - Street 1:170 N WOLFE RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-5211
Practice Address - Country:US
Practice Address - Phone:408-548-7104
Practice Address - Fax:408-404-8100
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor