Provider Demographics
NPI:1609131341
Name:MCCARTHY, PAUL (DC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:MCCARTHY
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 1:13520 S ROUTE 59
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-5545
Mailing Address - Country:US
Mailing Address - Phone:815-439-9800
Mailing Address - Fax:815-439-9804
Practice Address - Street 1:13520 S ROUTE 59
Practice Address - Street 2:SUITE 100
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5545
Practice Address - Country:US
Practice Address - Phone:815-439-9800
Practice Address - Fax:815-439-9804
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008938OtherLICENSE