Provider Demographics
NPI:1851374672
Name:MAZUR, ROBERT M (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:MAZUR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:45 W CROSSVILLE RD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2964
Mailing Address - Country:US
Mailing Address - Phone:678-461-3512
Mailing Address - Fax:678-461-3513
Practice Address - Street 1:45 W CROSSVILLE RD
Practice Address - Street 2:SUITE 503
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2964
Practice Address - Country:US
Practice Address - Phone:678-461-3512
Practice Address - Fax:678-461-3513
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACHIR007376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor