Provider Demographics
NPI:1689663551
Name:MACEACHERN, MICHAEL PATRICK (CHIRPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:MACEACHERN
Suffix:
Gender:M
Credentials:CHIRPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4111
Mailing Address - Country:US
Mailing Address - Phone:630-213-6646
Mailing Address - Fax:
Practice Address - Street 1:945 S BARTLETT RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2419
Practice Address - Country:US
Practice Address - Phone:630-483-8900
Practice Address - Fax:630-483-4337
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU20380Medicare UPIN