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General NPI Number Information
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NPI Number | 1003942905
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Entity Type | Individual
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Provider Name | JANUSZ MAZON D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1455 BELLS FERRY RD SUITE 200
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City | MARIETTA
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State | GA
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Zip | 30066-6078
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Country | US
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Telephone | 770-419-0570
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Fax | 678-581-1739
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Provider Business Mailing Address
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Address Line | 1366 PEMBRIDGE TRCE NW
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City | KENNESAW
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State | GA
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Zip | 30152-5471
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR007353
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License Number State | GA
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