Provider Demographics
NPI:1912002007
Name:MAZYAR MICHAEL NESHAT, D.C., P.A.
Entity Type:Organization
Organization Name:MAZYAR MICHAEL NESHAT, D.C., P.A.
Other - Org Name:MAZ CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZYAR
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NESHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-821-7700
Mailing Address - Street 1:616 INDIAN TRAIL RD S
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-9680
Mailing Address - Country:US
Mailing Address - Phone:704-821-7700
Mailing Address - Fax:704-821-7710
Practice Address - Street 1:616 INDIAN TRAIL RD S
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-9680
Practice Address - Country:US
Practice Address - Phone:704-821-7700
Practice Address - Fax:704-821-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2976111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC618261OtherUHC
NC618261OtherCIGNA
NC085EAOtherBCBS OF NC
NC5901819Medicaid
NC5901819Medicaid
NC085EAOtherBCBS OF NC