MEDICARE: MASON ELBERT

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	5924	MN

General Provider Information

NPI Number	:	1982941258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON ELBERT

Provider Business Mailing Address
First Line	:	311 2ND ST
Second Line	:
City	:	JACKSON
State	:	MN
Zip	:	56143-1639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 2ND ST
Second Line	:
City	:	JACKSON
State	:	MN
Zip	:	56143-1639
Country	:	US
Telephone Number	:	507-849-7310
Fax Number	:

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	09/30/2014

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Directions to “ MASON ELBERT ” Practice Location

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