Provider Demographics
NPI:1871703389
Name:ABDELMALEK, MAZIN (DC)
Entity type:Individual
Prefix:DR
First Name:MAZIN
Middle Name:
Last Name:ABDELMALEK
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 1:1501 S CENTER RD
Mailing Address - Street 2:BUILDING A
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1731
Mailing Address - Country:US
Mailing Address - Phone:810-715-7746
Mailing Address - Fax:810-715-7716
Practice Address - Street 1:1501 S CENTER RD
Practice Address - Street 2:BUILDING A
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1731
Practice Address - Country:US
Practice Address - Phone:810-715-7746
Practice Address - Fax:810-715-7716
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1871703389OtherBCN
MI134211491OtherCOMMERCIAL
MI4619068Medicaid
950B513520OtherBCBSM
MIN95580001Medicare ID - Type Unspecified
0N95580Medicare PIN