Provider Demographics
NPI:1104999457
Name:MAZZARA, DINO GERARD (DC)
Entity type:Individual
Prefix:DR
First Name:DINO
Middle Name:GERARD
Last Name:MAZZARA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E GENESEE ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3130
Mailing Address - Country:US
Mailing Address - Phone:315-314-7129
Mailing Address - Fax:315-314-7133
Practice Address - Street 1:600 E GENESEE ST
Practice Address - Street 2:SUITE 114
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3130
Practice Address - Country:US
Practice Address - Phone:315-314-7129
Practice Address - Fax:315-314-7133
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOOO8584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6U381Medicare ID - Type Unspecified
NYX6U381Medicare UPIN