Provider Demographics
NPI:1366546897
Name:MATOSHKO,BUTZIN AND ASSOCIATES
Entity type:Organization
Organization Name:MATOSHKO,BUTZIN AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-598-9120
Mailing Address - Street 1:27322 23 MILE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2032
Mailing Address - Country:US
Mailing Address - Phone:586-598-9120
Mailing Address - Fax:586-598-9155
Practice Address - Street 1:27322 23 MILE RD STE 3
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2032
Practice Address - Country:US
Practice Address - Phone:586-598-9120
Practice Address - Fax:586-598-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N98450Medicare ID - Type Unspecified