Provider Demographics
NPI:1922383041
Name:MCDONALD CHIROPRACTIC & ACUPUNCTURE, P.A.
Entity Type:Organization
Organization Name:MCDONALD CHIROPRACTIC & ACUPUNCTURE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-940-9813
Mailing Address - Street 1:124 TUSCAN WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1851
Mailing Address - Country:US
Mailing Address - Phone:904-940-9813
Mailing Address - Fax:904-940-1812
Practice Address - Street 1:124 TUSCAN WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1851
Practice Address - Country:US
Practice Address - Phone:904-940-9813
Practice Address - Fax:904-940-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty