Healthcare Provider Details

I. General information

NPI: 1508887589
Provider Name (Legal Business Name): PAUL WALTER MASALSKIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21021 FARMINGTON RD
FARMINGTON HILLS MI
48336-5016
US

IV. Provider business mailing address

31236 PIERCE ST
BEVERLY HILLS MI
48025-5416
US

V. Phone/Fax

Practice location:
  • Phone: 248-477-4200
  • Fax:
Mailing address:
  • Phone: 248-477-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2301004586
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: