MEDICARE: MAX MASTERS DC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301009746	MI

General Provider Information

NPI Number	:	1255700639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAX MASTERS DC PLLC

Provider Business Mailing Address
First Line	:	1675 PHOENIX ST STE 9
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-8658
Country	:	US
Telephone Number	:	269-639-2545
Fax Number	:	269-639-2137

Provider Business Practice Location Address
First Line	:	1675 PHOENIX ST STE 9
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-8658
Country	:	US
Telephone Number	:	269-639-2545
Fax Number	:	269-639-2137

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RONALD M MASTERS
Credential	:	DC
Telephone Number	:	269-639-2545

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	09/16/2015

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Directions to “MAX MASTERS DC PLLC ” Practice Location

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