MEDICARE: MR. SCOTT P MAYSTROVICH D.C.

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	CH00034050	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00021492	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010147569	OTHER	WA	REGENCE OF IDAHO
3	0157424	OTHER	WA	LABOR & INDUSTRIES
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2433MA	OTHER	WA	ASURIS

General Provider Information

NPI Number	:	1114910270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT P MAYSTROVICH D.C.

Provider Business Mailing Address
First Line	:	5625 N WALL ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-6435
Country	:	US
Telephone Number	:	509-482-1982
Fax Number	:	509-482-1983

Provider Business Practice Location Address
First Line	:	5625 N WALL ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-6435
Country	:	US
Telephone Number	:	509-482-1982
Fax Number	:	509-482-1983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. SCOTT P MAYSTROVICH D.C.” Practice Location

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