Provider Demographics
NPI:1508165580
Name:MACNAUGHTON CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:MACNAUGHTON CHIROPRACTIC, PLLC
Other - Org Name:BACK IN BALANCE HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MACNAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-223-0331
Mailing Address - Street 1:13 CHESTER STREET
Mailing Address - Street 2:
Mailing Address - City:GLEN FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-223-0331
Mailing Address - Fax:518-223-0331
Practice Address - Street 1:13 CHESTER STREET
Practice Address - Street 2:
Practice Address - City:GLEN FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-223-0331
Practice Address - Fax:518-223-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010161111N00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1CRB3332Medicare UPIN
1CRB3332Medicare UPIN