Provider Demographics
NPI:1053466466
Name:MASKER, THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:MASKER
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:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:WYSOX
Mailing Address - State:PA
Mailing Address - Zip Code:18854
Mailing Address - Country:US
Mailing Address - Phone:570-265-6352
Mailing Address - Fax:
Practice Address - Street 1:RT 6 BOX 561
Practice Address - Street 2:
Practice Address - City:WYSOX
Practice Address - State:PA
Practice Address - Zip Code:18854
Practice Address - Country:US
Practice Address - Phone:570-265-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0054832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U58545Medicare UPIN
MA612632Medicare ID - Type Unspecified