Provider Demographics
NPI:1790862662
Name:MAGWOOD, MICHAEL R (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:MAGWOOD
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 1:1425 BROAD ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-4201
Mailing Address - Country:US
Mailing Address - Phone:201-400-2367
Mailing Address - Fax:973-592-0474
Practice Address - Street 1:1425 BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4201
Practice Address - Country:US
Practice Address - Phone:973-773-8244
Practice Address - Fax:973-591-0474
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00583300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00408818OtherRAILROAD MEDICARE
NJP00408818OtherRAILROAD MEDICARE