Provider Demographics
NPI:1306483052
Name:EZER, MAYA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:ANN
Last Name:EZER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:ANN
Other - Last Name:DOROSCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3454 RICE STREET N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55126
Mailing Address - Country:US
Mailing Address - Phone:651-483-4321
Mailing Address - Fax:651-483-3440
Practice Address - Street 1:3454 RICE STREET N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126
Practice Address - Country:US
Practice Address - Phone:651-483-4321
Practice Address - Fax:651-483-3440
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor