Provider Demographics
NPI:1780740233
Name:JOHN C. MACAULAY & JOSEPHINE C. KINNEY
Entity type:Organization
Organization Name:JOHN C. MACAULAY & JOSEPHINE C. KINNEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:MACAULAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-296-5560
Mailing Address - Street 1:403 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1805
Mailing Address - Country:US
Mailing Address - Phone:610-296-5560
Mailing Address - Fax:610-296-5560
Practice Address - Street 1:403 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1805
Practice Address - Country:US
Practice Address - Phone:610-296-5560
Practice Address - Fax:610-296-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PWWH116221OtherHIGHMARK BLUE SHIELD
PA0274895000OtherINDEPENDENCE BLUE CROSS
PAWH116221OtherHIGHMARK BLUE SHIELD
4488453OtherAETNA
4488453OtherAETNA
F1022Medicare ID - Type UnspecifiedPALMETTO GBA (RRMEDICARE)