Provider Demographics
NPI:1871669697
Name:MCMAHON, MICHAEL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MCMAHON
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 1:4330 GOLF TER STE 107
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7984
Mailing Address - Country:US
Mailing Address - Phone:715-834-4516
Mailing Address - Fax:715-834-0552
Practice Address - Street 1:4330 GOLF TER STE 107
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7984
Practice Address - Country:US
Practice Address - Phone:715-834-4516
Practice Address - Fax:715-834-0552
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38765500Medicaid
WI38765500Medicaid