Provider Demographics
NPI:1023414315
Name:MACIJESKI, MICHAEL THEOPHILUS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THEOPHILUS
Last Name:MACIJESKI
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 1:160 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4531
Mailing Address - Country:US
Mailing Address - Phone:401-435-2002
Mailing Address - Fax:401-435-3553
Practice Address - Street 1:1155 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-2107
Practice Address - Country:US
Practice Address - Phone:401-725-2112
Practice Address - Fax:401-725-0066
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor