Provider Demographics
NPI:1841407533
Name:MAZZOLA, DEBRA (DC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MAZZOLA
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 1:9550 W VAN BUREN STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-2827
Mailing Address - Country:US
Mailing Address - Phone:623-907-0454
Mailing Address - Fax:623-907-0493
Practice Address - Street 1:9550 W VAN BUREN STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-2827
Practice Address - Country:US
Practice Address - Phone:623-907-0454
Practice Address - Fax:623-907-0493
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0942270OtherBCBS
Z76993Medicare ID - Type Unspecified
U97558Medicare UPIN