Provider Demographics
NPI:1073843553
Name:MCCAULEY, MARK ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:MCCAULEY
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 1:271 ATLANTA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1301
Mailing Address - Country:US
Mailing Address - Phone:412-592-6849
Mailing Address - Fax:
Practice Address - Street 1:271 ATLANTA DR
Practice Address - Street 2:
Practice Address - City:MOUNT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-1301
Practice Address - Country:US
Practice Address - Phone:412-592-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor