MEDICARE: DR. JEFFREY SCOTT MATOSHKO DC

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	JM005363	MI

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

General Provider Information

NPI Number	:	1689781023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY SCOTT MATOSHKO DC

Provider Business Mailing Address
First Line	:	5754 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5777
Country	:	US
Telephone Number	:	586-795-8989
Fax Number	:	586-999-5989

Provider Business Practice Location Address
First Line	:	5754 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5777
Country	:	US
Telephone Number	:	586-795-8989
Fax Number	:	586-999-5989

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	04/01/2022

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