MEDICARE: JACK MELVIN MASCHE 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	1764012	WI

General Provider Information

NPI Number	:	1205913530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK MELVIN MASCHE D.C.

Provider Business Mailing Address
First Line	:	5055 S 110TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53228-3131
Country	:	US
Telephone Number	:	414-529-5370
Fax Number	:	414-529-5376

Provider Business Practice Location Address
First Line	:	5055 S 110TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53228-3131
Country	:	US
Telephone Number	:	414-529-5370
Fax Number	:	414-529-5376

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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