Provider Demographics
NPI:1952454399
Name:MCCREARY, MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:MCCREARY
Suffix:
Gender:F
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:PO BOX 5805
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93005-0805
Mailing Address - Country:US
Mailing Address - Phone:805-650-9665
Mailing Address - Fax:805-650-9665
Practice Address - Street 1:1655 MESA VERDE AVE
Practice Address - Street 2:#100
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6518
Practice Address - Country:US
Practice Address - Phone:805-650-9665
Practice Address - Fax:805-650-9665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC214291OtherBLUE SHIELD
CADC214291OtherBLUE SHIELD