Healthcare Provider Details

I. General information

NPI: 1851414528
Provider Name (Legal Business Name): ROBERT MAZAL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MAIN ST
MONROE CT
06468-1116
US

IV. Provider business mailing address

360 WESTPORT AVE SUITE 3
NORWALK CT
06851-4348
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-0400
  • Fax:
Mailing address:
  • Phone: 203-650-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001586
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: