Provider Demographics
NPI:1639206071
Name:MASIAS CHIORPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:MASIAS CHIORPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:MASIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-501-9108
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA1686436OtherBLUE CROSS BLUE SHIELD
PAV00709Medicare UPIN