Provider Demographics
NPI:1396271995
Name:MACDONALD CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:MACDONALD CHIROPRACTIC CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-733-0310
Mailing Address - Street 1:5154 MILLER RD
Mailing Address - Street 2:STE. J
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1065
Mailing Address - Country:US
Mailing Address - Phone:810-733-0310
Mailing Address - Fax:810-733-5554
Practice Address - Street 1:5154 MILLER RD
Practice Address - Street 2:STE. J
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1065
Practice Address - Country:US
Practice Address - Phone:810-733-0310
Practice Address - Fax:810-733-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty