Provider Demographics
NPI:1144328006
Name:MAZURE, PHILIPPE E (DC)
Entity type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:E
Last Name:MAZURE
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 1:125 NE 8TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030
Mailing Address - Country:US
Mailing Address - Phone:305-247-2804
Mailing Address - Fax:305-247-9471
Practice Address - Street 1:125 NE 8TH ST #3
Practice Address - Street 2:SUITE 3
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030
Practice Address - Country:US
Practice Address - Phone:305-247-2804
Practice Address - Fax:305-247-9471
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059345100Medicaid
U05294Medicare UPIN
FL059345100Medicaid