MEDICARE: MATOSHKO,BUTZIN AND 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

General Provider Information

NPI Number	:	1366546897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATOSHKO,BUTZIN AND ASSOCIATES

Provider Business Mailing Address
First Line	:	27322 23 MILE RD STE 3
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2032
Country	:	US
Telephone Number	:	586-598-9120
Fax Number	:	586-598-9155

Provider Business Practice Location Address
First Line	:	27322 23 MILE RD STE 3
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2032
Country	:	US
Telephone Number	:	586-598-9120
Fax Number	:	586-598-9155

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS BRIANNA A KRUK
Credential	:
Telephone Number	:	586-598-9120

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	10/03/2007

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