Healthcare Provider Details

I. General information

NPI: 1033202890
Provider Name (Legal Business Name): MICHAEL THEODORE MASIAS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 N LOCUST ST
HAZLETON PA
18201-5740
US

IV. Provider business mailing address

64 N LOCUST ST
HAZLETON PA
18201-5740
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-9108
  • Fax: 570-501-9150
Mailing address:
  • Phone: 570-501-9108
  • Fax: 570-501-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009223
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberAJ009055
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier818948
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH
# 2
IdentifierMA1619029
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: