Healthcare Provider Details

I. General information

NPI: 1982965257
Provider Name (Legal Business Name): MACDONALD CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 GIFFORD ST
FALMOUTH MA
02540-3309
US

IV. Provider business mailing address

169 GIFFORD ST
FALMOUTH MA
02540-3309
US

V. Phone/Fax

Practice location:
  • Phone: 508-548-2201
  • Fax: 508-548-2280
Mailing address:
  • Phone: 508-548-2201
  • Fax: 508-548-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number503
License Number StateMA

VIII. Authorized Official

Name: DR. DAVID GLENN MACDONALD
Title or Position: TREASURER
Credential: DC
Phone: 508-548-2201