Healthcare Provider Details

I. General information

NPI: 1154040780
Provider Name (Legal Business Name): BROOKE MAZUJIAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 S CARTER RD UNIT 5
SMYRNA DE
19977-7754
US

IV. Provider business mailing address

5370 FARM LN
GREENWOOD DE
19950-4442
US

V. Phone/Fax

Practice location:
  • Phone: 302-389-8915
  • Fax:
Mailing address:
  • Phone: 302-222-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0011089
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: