Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 0104556439 | VA |
N | 111NR0400X | Rehabilitation Chiropractor | DC009617 | PA |
NPI | 1386791820 |
---|---|
Provider Name | Dr. Jason Mazzarella |
First Address | Manassas, VA 20109-7861 |
Second Address | Manassas, VA 20109-2859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |