Provider Demographics
NPI:1578668851
Name:MCDONALD CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MCDONALD CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-328-8212
Mailing Address - Street 1:36945 COOK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6077
Mailing Address - Country:US
Mailing Address - Phone:760-328-8212
Mailing Address - Fax:760-328-8216
Practice Address - Street 1:36945 COOK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6077
Practice Address - Country:US
Practice Address - Phone:760-328-8212
Practice Address - Fax:760-328-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16732111N00000X
CADC24574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02737ZMedicare PIN
CA6348620001Medicare NSC