Provider Demographics
NPI:1992013510
Name:MCCAULLEY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MCCAULLEY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:MCCAULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-362-1225
Mailing Address - Street 1:1919 W 57TH ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2711
Mailing Address - Country:US
Mailing Address - Phone:605-362-1225
Mailing Address - Fax:605-362-9525
Practice Address - Street 1:1919 W 57TH ST
Practice Address - Street 2:STE. 103
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2711
Practice Address - Country:US
Practice Address - Phone:605-362-1225
Practice Address - Fax:605-362-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty