Provider Demographics
NPI:1619150075
Name:MACONACHIE, JILLIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:MACONACHIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6243 TYRE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-2300
Mailing Address - Country:US
Mailing Address - Phone:907-222-6121
Mailing Address - Fax:
Practice Address - Street 1:6243 TYRE CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2300
Practice Address - Country:US
Practice Address - Phone:907-222-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK465111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic