Provider Demographics
NPI:1689962391
Name:MCMAHAN, CHAD (DC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:MCMAHAN
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 1:2721 S COLLEGE AVE UNIT 4A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2160
Mailing Address - Country:US
Mailing Address - Phone:970-377-2250
Mailing Address - Fax:970-377-2251
Practice Address - Street 1:2721 S COLLEGE AVE UNIT 4A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2160
Practice Address - Country:US
Practice Address - Phone:970-377-2250
Practice Address - Fax:970-377-2251
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor