Provider Demographics
NPI:1104981257
Name:MAZZIE, WILLIAM N (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:N
Last Name:MAZZIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:N
Other - Last Name:MAZZIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:818 EAST PITTSBURGH PLAZA
Mailing Address - Street 2:
Mailing Address - City:EAST PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15112
Mailing Address - Country:US
Mailing Address - Phone:412-823-2460
Mailing Address - Fax:
Practice Address - Street 1:818 EAST PITTSBURGH PLAZA
Practice Address - Street 2:
Practice Address - City:EAST PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15112
Practice Address - Country:US
Practice Address - Phone:412-823-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001783L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021031Medicare ID - Type Unspecified