Provider Demographics
NPI:1477829745
Name:MCNALLY SPINAL CARE, LLC
Entity type:Organization
Organization Name:MCNALLY SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-372-5900
Mailing Address - Street 1:1021 N. SUPERIOR AVE.
Mailing Address - Street 2:SUITE #9
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-1192
Mailing Address - Country:US
Mailing Address - Phone:608-372-5900
Mailing Address - Fax:608-372-5800
Practice Address - Street 1:1021 N. SUPERIOR AVE.
Practice Address - Street 2:SUITE #9
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-1192
Practice Address - Country:US
Practice Address - Phone:608-372-5900
Practice Address - Fax:608-372-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3654012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035437Medicare UPIN