Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC009223 | PA |
N | 111NR0400X | Rehabilitation Chiropractor | AJ009055 | PA |
NPI | 1033202890 |
---|---|
Provider Name | Dr. Michael Theodore Masias |
First Address | Hazleton, PA 18201-5740 |
Second Address | Hazleton, PA 18201-5740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
818948 | FIRST PRIORITY HEALTH (01) | PA |
MA1619029 | BLUE CROSS BLUE SHIELD (01) | PA |
V00709 | (02) | PA |