MEDICARE: BUTZIN, MATOSHKO & ASSOCIATES

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	JB008115	MI
2	111N00000X	Chiropractor	JM005363	MI

General Provider Information

NPI Number	:	1144595802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTZIN, MATOSHKO & ASSOCIATES

Provider Business Mailing Address
First Line	:	2050 CHESLEY DR
Second Line	:	SUITE 2
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4818
Country	:	US
Telephone Number	:	586-268-8882
Fax Number	:	586-268-5305

Provider Business Practice Location Address
First Line	:	2050 CHESLEY DR
Second Line	:	SUITE 2
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4818
Country	:	US
Telephone Number	:	586-268-8882
Fax Number	:	586-268-5305

Authorized Official
Title or Position	:	PART OWNER
Name	:	DR. JASON ALAN BUTZIN
Credential	:	D.C.
Telephone Number	:	586-268-8882

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	03/14/2012

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