Provider Demographics
NPI:1457740169
Name:MACCARRY DAVIS CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:MACCARRY DAVIS CHIROPRACTIC CORP
Other - Org Name:MOUNTAIN MEADOW CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN-ELIZABETH
Authorized Official - Middle Name:MACCARRY
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-577-4757
Mailing Address - Street 1:15520 ROCKFIELD BLVD STE A200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:591 TAHOE KEYS BLVD STE D3
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3359
Practice Address - Country:US
Practice Address - Phone:530-577-4757
Practice Address - Fax:530-600-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty