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General NPI Number Information
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NPI Number | 1568529592
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Entity Type | Organization
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Legal Business Name | MAZYAR NESHAT, D.C., P.A.
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 1001 VAN BUREN AVE STE E
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5584
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Country | US
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Telephone | 704-882-2255
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Fax | 704-882-2252
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Provider Business Mailing Address
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Address Line | 1001 VAN BUREN AVE STE E
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5584
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Country | US
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Telephone | 704-882-2255
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Fax | 704-882-2252
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAZYAR MICHAEL NESHAT
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Credential | DC
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Telephone | 704-882-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2976
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License Number State | NC
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