Provider Demographics
NPI:1952324691
Name:MCDONALD, JOHN R JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MCDONALD
Suffix:JR
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 1:1055 W QUEEN CREEK RD
Mailing Address - Street 2:STE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-8134
Mailing Address - Country:US
Mailing Address - Phone:480-814-7115
Mailing Address - Fax:480-814-7792
Practice Address - Street 1:1055 W QUEEN CREEK RD
Practice Address - Street 2:STE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-8134
Practice Address - Country:US
Practice Address - Phone:480-814-7115
Practice Address - Fax:480-814-7792
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005567111N00000X
AZ4200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10182043OtherBCBS
IL10182043OtherBCBS