Physician Compare National (NPI:1669959870)

HEALTHCARE PROVIDER: JONATHAN MACZKO

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1669959870
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9032456637
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190121000029
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MACZKO
	Individual professional last name
Provider First Name	JONATHAN
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2018
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PHYSICAL MEDICINE AND REHABILITATION
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PHYSICAL MEDICINE AND REHABILITATION
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	6710 WOODLAND BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 3
	Group Practice or individual's line 2 address
City	HICKMAN
	Group Practice or individual's city
State	NE
	Group Practice or individual's state
Zip Code	683729626
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y