MEDICARE: DR. JOHN JOSEPH MAZZELLA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	MC04441	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MC04441	OTHER	NJ	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1235275074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JOSEPH MAZZELLA D.C.

Provider Business Mailing Address
First Line	:	2397 STATE ROUTE 36
Second Line	:
City	:	ATLANTIC HIGHLANDS
State	:	NJ
Zip	:	07716-2532
Country	:	US
Telephone Number	:	732-872-6595
Fax Number	:	732-872-1508

Provider Business Practice Location Address
First Line	:	2397 STATE ROUTE 36
Second Line	:
City	:	ATLANTIC HIGHLANDS
State	:	NJ
Zip	:	07716-2532
Country	:	US
Telephone Number	:	732-872-6595
Fax Number	:	732-872-1508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	12/28/2007

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