Provider Demographics
NPI:1033202890
Name:MASIAS, MICHAEL THEODORE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THEODORE
Last Name:MASIAS
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 1:64 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5740
Mailing Address - Country:US
Mailing Address - Phone:570-501-9108
Mailing Address - Fax:570-501-9150
Practice Address - Street 1:64 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5740
Practice Address - Country:US
Practice Address - Phone:570-501-9108
Practice Address - Fax:570-501-9150
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009223111N00000X
PAAJ009055111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA818948OtherFIRST PRIORITY HEALTH
PAMA1619029OtherBLUE CROSS BLUE SHIELD
PA081604Medicare ID - Type Unspecified
PAV00709Medicare UPIN