MEDICARE: GREGORY NICHOLAS MAZZOTTA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH8707	FL

General Provider Information

NPI Number	:	1336229343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY NICHOLAS MAZZOTTA D.C.

Provider Business Mailing Address
First Line	:	2601 SW 37TH AVE
Second Line	:	SUITE 607
City	:	MIAMI
State	:	FL
Zip	:	33133-2700
Country	:	US
Telephone Number	:	305-445-5056
Fax Number	:	305-445-2023

Provider Business Practice Location Address
First Line	:	1490 NE MIAMI GARDENS DR
Second Line	:
City	:	N MIAMI BEACH
State	:	FL
Zip	:	33179-4829
Country	:	US
Telephone Number	:	305-944-3310
Fax Number	:	305-944-8655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	09/24/2008

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