Provider Demographics
NPI:1154487312
Name:MCCANN FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MCCANN FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-657-7183
Mailing Address - Street 1:11605 STATE AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8427
Mailing Address - Country:US
Mailing Address - Phone:360-657-7183
Mailing Address - Fax:360-657-7188
Practice Address - Street 1:11605 STATE AVE
Practice Address - Street 2:STE 111
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8427
Practice Address - Country:US
Practice Address - Phone:360-657-7183
Practice Address - Fax:360-657-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty