Provider Demographics
NPI:1689781023
Name:MATOSHKO, JEFFREY SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:MATOSHKO
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 1:5754 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5777
Mailing Address - Country:US
Mailing Address - Phone:586-795-8989
Mailing Address - Fax:586-999-5989
Practice Address - Street 1:5754 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5777
Practice Address - Country:US
Practice Address - Phone:586-795-8989
Practice Address - Fax:586-999-5989
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM005363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4754035Medicaid
MI4754035Medicaid
MIN98450002Medicare ID - Type Unspecified