Provider Demographics
NPI:1144595802
Name:BUTZIN, MATOSHKO & ASSOCIATES
Entity Type:Organization
Organization Name:BUTZIN, MATOSHKO & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BUTZIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-268-8882
Mailing Address - Street 1:2050 CHESLEY DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4818
Mailing Address - Country:US
Mailing Address - Phone:586-268-8882
Mailing Address - Fax:586-268-5305
Practice Address - Street 1:2050 CHESLEY DR
Practice Address - Street 2:SUITE 2
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4818
Practice Address - Country:US
Practice Address - Phone:586-268-8882
Practice Address - Fax:586-268-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB008115111N00000X
MIJM005363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION42310Medicare UPIN