Provider Demographics
NPI:1710232335
Name:MACIOCE CHIROPRACTIC L. L. C.
Entity Type:Organization
Organization Name:MACIOCE CHIROPRACTIC L. L. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MACIOCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-494-8787
Mailing Address - Street 1:9479 GARLAND LANE N.
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-5480
Mailing Address - Country:US
Mailing Address - Phone:763-494-8787
Mailing Address - Fax:763-494-8841
Practice Address - Street 1:9479 GARLAND LANE N.
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-5480
Practice Address - Country:US
Practice Address - Phone:763-494-8787
Practice Address - Fax:763-494-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty