Provider Demographics
NPI:1336229343
Name:MAZZOTTA, GREGORY NICHOLAS (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:NICHOLAS
Last Name:MAZZOTTA
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 1:2601 SW 37TH AVE
Mailing Address - Street 2:SUITE 607
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2700
Mailing Address - Country:US
Mailing Address - Phone:305-445-5056
Mailing Address - Fax:305-445-2023
Practice Address - Street 1:1490 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4829
Practice Address - Country:US
Practice Address - Phone:305-944-3310
Practice Address - Fax:305-944-8655
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor