Healthcare Provider Details

I. General information

NPI: 1497820427
Provider Name (Legal Business Name): KEITH MAZANOWSKI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 PARKER ROAD
EATONTOWN NJ
07724
US

IV. Provider business mailing address

450 SHREWSBURY PLAZA SUITE 291
SHREWSBURY NJ
07702
US

V. Phone/Fax

Practice location:
  • Phone: 732-229-3344
  • Fax: 732-728-0870
Mailing address:
  • Phone: 732-229-3344
  • Fax: 732-728-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC02570
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: