Healthcare Provider Details

I. General information

NPI: 1487733713
Provider Name (Legal Business Name): PAUL C. MACH DN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3129 SPAULDING ORCHARD RD
SPRINGFIELD IL
62711-7318
US

IV. Provider business mailing address

3129 SPAULDING ORCHARD RD
SPRINGFIELD IL
62711-7318
US

V. Phone/Fax

Practice location:
  • Phone: 217-638-6224
  • Fax:
Mailing address:
  • Phone: 217-638-6224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181000180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: