Provider Demographics
NPI:1982965257
Name:MACDONALD CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MACDONALD CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-548-2201
Mailing Address - Street 1:169 GIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-3309
Mailing Address - Country:US
Mailing Address - Phone:508-548-2201
Mailing Address - Fax:508-548-2280
Practice Address - Street 1:169 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3309
Practice Address - Country:US
Practice Address - Phone:508-548-2201
Practice Address - Fax:508-548-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA503261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0045269OtherNHP
MA1608479Medicaid
MA0005681463OtherAETNA
MA35239OtherHARVARD PILGRIM HEALTH CARE
MAY35334OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MA762446OtherTUFTS
MAT58116Medicare UPIN