MEDICARE: MAZYAR MICHAEL NESHAT, D.C., P.A.

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	111NS0005X	Sports Physician Chiropractor	2976	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	618261	OTHER	NC	UHC
2	618261	OTHER	NC	CIGNA
3	085EA	OTHER	NC	BCBS OF NC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912002007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAZYAR MICHAEL NESHAT, D.C., P.A.

Provider Business Mailing Address
First Line	:	616 INDIAN TRAIL RD S
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-9680
Country	:	US
Telephone Number	:	704-821-7700
Fax Number	:	704-821-7710

Provider Business Practice Location Address
First Line	:	616 INDIAN TRAIL RD S
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-9680
Country	:	US
Telephone Number	:	704-821-7700
Fax Number	:	704-821-7710

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAZYAR MICHAEL NESHAT
Credential	:	D.C.
Telephone Number	:	704-821-7700

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/22/2020

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