Provider Demographics
NPI:1467449496
Name:MACPHERSON, DOUGLAS (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:MACPHERSON
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:PO BOX 2367
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1567
Mailing Address - Country:US
Mailing Address - Phone:304-723-5340
Mailing Address - Fax:304-723-0438
Practice Address - Street 1:2423 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3632
Practice Address - Country:US
Practice Address - Phone:304-723-5340
Practice Address - Fax:304-723-0438
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0495889Medicaid
WV0132374000Medicaid
OH0495889Medicaid
WV0510672Medicare ID - Type Unspecified
WV9365211Medicare ID - Type Unspecified