Provider Demographics
NPI:1609845841
Name:MAZIQUE, SHAUNA M (DC)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:M
Last Name:MAZIQUE
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 1:498 WANDO PARK BLVD STE 1150
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7971
Mailing Address - Country:US
Mailing Address - Phone:843-940-5166
Mailing Address - Fax:
Practice Address - Street 1:498 WANDO PARK BLVD STE 1150
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7971
Practice Address - Country:US
Practice Address - Phone:843-940-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA12570281Medicare PIN