Provider Demographics
NPI:1063467330
Name:MCAULLIFFE, THOMAS B (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:MCAULLIFFE
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 1:1116 ARSENAL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2528
Mailing Address - Country:US
Mailing Address - Phone:315-782-7166
Mailing Address - Fax:
Practice Address - Street 1:25987 LITTLE OWL CT
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-4189
Practice Address - Country:US
Practice Address - Phone:607-760-8432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009253111N00000X
NYX010867-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018654700006Medicaid
PA0018654700006Medicaid
PA080884PWPMedicare ID - Type Unspecified