Provider Demographics
NPI:1386791820
Name:MAZZARELLA, JASON (DC, FIAMA)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:MAZZARELLA
Suffix:
Gender:M
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11290 CHATTERLY LOOP
Mailing Address - Street 2:#203
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7861
Mailing Address - Country:US
Mailing Address - Phone:571-309-6546
Mailing Address - Fax:
Practice Address - Street 1:7806 SUDLEY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2859
Practice Address - Country:US
Practice Address - Phone:571-309-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556439111NR0400X
PADC009617111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation