MEDICARE: DR. ROBERT MAZAL 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	001586	CT

General Provider Information

NPI Number	:	1851414528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MAZAL D.C.

Provider Business Mailing Address
First Line	:	360 WESTPORT AVE
Second Line	:	SUITE 3
City	:	NORWALK
State	:	CT
Zip	:	06851-4348
Country	:	US
Telephone Number	:	203-650-3489
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 MAIN ST
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-1116
Country	:	US
Telephone Number	:	203-845-0400
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	02/12/2010

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