Healthcare Provider Details

I. General information

NPI: 1710329214
Provider Name (Legal Business Name): MCNAMARA CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 FAIRVIEW AVE SUITE 5
DOWNERS GROVE IL
60515-3999
US

IV. Provider business mailing address

5010 FAIRVIEW AVE SUITE 5
DOWNERS GROVE IL
60515-3999
US

V. Phone/Fax

Practice location:
  • Phone: 630-964-7660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012451
License Number StateIL

VIII. Authorized Official

Name: DR. MACKENZIE MCNAMARA
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 630-964-7660