Provider Demographics
NPI:1063502045
Name:MCDONALD, WILLIAM PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAUL
Last Name:MCDONALD
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 1:220 WASHINGTON ST W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302
Mailing Address - Country:US
Mailing Address - Phone:304-345-1466
Mailing Address - Fax:304-345-1469
Practice Address - Street 1:220 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-345-1466
Practice Address - Fax:304-345-1469
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131285000Medicaid
WV001720504OtherMT STATE BLUE CROSS/SHIEL
55-0649349OtherFEIN #
WVT32385Medicare UPIN
WVMC0567211Medicare ID - Type Unspecified