Provider Demographics
NPI:1427008481
Name:MCDONALD, CARY BLAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:BLAINE
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 1:2239 S COTTONWOOD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6389
Mailing Address - Country:US
Mailing Address - Phone:480-214-0673
Mailing Address - Fax:
Practice Address - Street 1:2145 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1503
Practice Address - Country:US
Practice Address - Phone:480-214-0673
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU24425Medicare UPIN