Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR007353 | GA |
NPI | 1003942905 |
---|---|
Provider Name | Mr. Janusz Mazon |
First Address | Kennesaw, GA 30152-5471 |
Second Address | Marietta, GA 30066-6078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |