Provider Demographics
NPI:1437441409
Name:MCDONALD, IAN MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:MATTHEW
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 1:936 CHESTERFIELD PKWY E
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2042
Mailing Address - Country:US
Mailing Address - Phone:636-537-0564
Mailing Address - Fax:
Practice Address - Street 1:936 CHESTERFIELD PKWY E
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2042
Practice Address - Country:US
Practice Address - Phone:636-537-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011012735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor