Provider Demographics
NPI:1457574063
Name:MACKO, THOMAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:MACKO
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:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-0747
Mailing Address - Country:US
Mailing Address - Phone:610-434-9990
Mailing Address - Fax:610-434-6526
Practice Address - Street 1:3251 SEVENTH ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052
Practice Address - Country:US
Practice Address - Phone:610-434-9990
Practice Address - Fax:610-434-6526
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002876L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA54802OtherAETNA
PA01427401OtherCBC ASHN
PA01020625 001Medicaid
PA01020625 001Medicaid
T72382Medicare UPIN