Healthcare Provider Details

I. General information

NPI: 1740353440
Provider Name (Legal Business Name): MARC A MIZZER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 KEY WEST AVE STE 30
ROCKVILLE MD
20850
US

IV. Provider business mailing address

9420 KEY WEST AVE STE 302
ROCKVILLE MD
20850-6212
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-3200
  • Fax: 301-762-3200
Mailing address:
  • Phone: 301-762-3200
  • Fax: 301-762-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS03444
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: