Provider Demographics
NPI:1760588313
Name:MCCALE, CARL S (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:S
Last Name:MCCALE
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 1:1605 GRAND CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105
Mailing Address - Country:US
Mailing Address - Phone:304-295-5505
Mailing Address - Fax:304-295-0503
Practice Address - Street 1:1605 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105
Practice Address - Country:US
Practice Address - Phone:304-295-5505
Practice Address - Fax:304-295-0503
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7600003000Medicaid
WV5723775OtherAETNA
WVU74327OtherCARELINK
WV275961OtherMAMSI
WVU74375Medicare UPIN
WV9369841Medicare PIN