Provider Demographics
NPI:1033177142
Name:MCCRACKEN, MICHAEL BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WARREN ST
Mailing Address - Street 2:APT 1
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-5240
Mailing Address - Country:US
Mailing Address - Phone:617-529-4169
Mailing Address - Fax:
Practice Address - Street 1:54 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2606
Practice Address - Country:US
Practice Address - Phone:978-463-8881
Practice Address - Fax:978-463-4441
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3026111N00000X
VA0104556361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y45812Medicare ID - Type Unspecified