Provider Demographics
NPI:1710967757
Name:MASKALY, JASON LLOYD (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LLOYD
Last Name:MASKALY
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:RR 3 BOX 3258
Mailing Address - Street 2:
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419-9323
Mailing Address - Country:US
Mailing Address - Phone:570-945-3373
Mailing Address - Fax:570-945-3552
Practice Address - Street 1:RR 3 BOX 3258
Practice Address - Street 2:
Practice Address - City:FACTORYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18419-9323
Practice Address - Country:US
Practice Address - Phone:570-945-3373
Practice Address - Fax:570-945-3552
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007920-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018453410001Medicaid
PA440659OtherFIRST PRIORITY HEALTH
PA7489251OtherAETNA
PA928167OtherBLUE CROSS BLUE SHIELD
PA440659OtherFIRST PRIORITY HEALTH
PAU84770Medicare UPIN