Healthcare Provider Details

I. General information

NPI: 1487087912
Provider Name (Legal Business Name): DAVID CARMINE MAZZOLA JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 SWAMP PIKE
GILBERTSVILLE PA
19525-9307
US

IV. Provider business mailing address

984 ENGLESVILLE HILL RD
BOYERTOWN PA
19512-8458
US

V. Phone/Fax

Practice location:
  • Phone: 610-327-3363
  • Fax:
Mailing address:
  • Phone: 610-568-0519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC010771
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: