Provider Demographics
NPI:1801079256
Name:MCCRACKEN, MICHAEL PARK
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PARK
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 MAYBERRY LANDING DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-1918
Mailing Address - Country:US
Mailing Address - Phone:214-886-1862
Mailing Address - Fax:
Practice Address - Street 1:6521 HIGHWAY 69 S
Practice Address - Street 2:SUITE N
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-3964
Practice Address - Country:US
Practice Address - Phone:205-345-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor