MEDICARE: DR. RONALD MAXWELL MASTERS 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	2301009746	MI
2	111N00000X	Chiropractor	038012165	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	950A310570	OTHER	MI	BCBSM
3	G06732	OTHER	MI	BCN

General Provider Information

NPI Number	:	1366748923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD MAXWELL MASTERS D.C.

Provider Business Mailing Address
First Line	:	1675 PHOENIX ST STE 9
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-8658
Country	:	US
Telephone Number	:	269-639-2545
Fax Number	:	269-639-2137

Provider Business Practice Location Address
First Line	:	1675 PHOENIX ST STE 9
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-8658
Country	:	US
Telephone Number	:	269-639-2545
Fax Number	:	269-639-2137

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

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	09/16/2015

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