Provider Demographics
NPI:1285737270
Name:VANZIE, MICHAEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:VANZIE
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 1:561 MACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1515
Mailing Address - Country:US
Mailing Address - Phone:718-649-6324
Mailing Address - Fax:718-649-6357
Practice Address - Street 1:8925 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3613
Practice Address - Country:US
Practice Address - Phone:718-649-6324
Practice Address - Fax:718-649-6357
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX2D15ZXP11Medicare PIN