Provider Demographics
NPI:1376625079
Name:MACNAUGHTON, CHAD DERRICK (DC, FNP)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DERRICK
Last Name:MACNAUGHTON
Suffix:
Gender:M
Credentials:DC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2913
Mailing Address - Country:US
Mailing Address - Phone:518-223-0331
Mailing Address - Fax:518-223-0331
Practice Address - Street 1:13 CHESTER ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2913
Practice Address - Country:US
Practice Address - Phone:518-223-0331
Practice Address - Fax:518-223-0331
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0101611111N00000X
NYF348808-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor