Provider Demographics
NPI:1154694156
Name:GAZONAS, OLGA (DC)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:GAZONAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 31ST ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1760
Mailing Address - Country:US
Mailing Address - Phone:718-956-6565
Mailing Address - Fax:718-956-5890
Practice Address - Street 1:2818 31ST ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1760
Practice Address - Country:US
Practice Address - Phone:718-956-6565
Practice Address - Fax:718-956-5890
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003788-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor