Provider Demographics
NPI:1154450625
Name:MCGONAGLE, DAVID J (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MCGONAGLE
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 1:221 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1717
Mailing Address - Country:US
Mailing Address - Phone:610-838-1703
Mailing Address - Fax:610-838-7649
Practice Address - Street 1:221 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1717
Practice Address - Country:US
Practice Address - Phone:610-838-1703
Practice Address - Fax:610-838-7649
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006701L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA871278Medicare ID - Type Unspecified