Provider Demographics
NPI:1114115789
Name:TASCO FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:TASCO FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:TASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-608-2675
Mailing Address - Street 1:115 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2011
Mailing Address - Country:US
Mailing Address - Phone:248-608-2675
Mailing Address - Fax:248-608-2574
Practice Address - Street 1:115 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2011
Practice Address - Country:US
Practice Address - Phone:248-608-2675
Practice Address - Fax:248-608-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F338340OtherBLUE CROSS BLUE SHIELD
MI=========OtherCOMMERCIAL
MI950F338340OtherBLUE CROSS BLUE SHIELD