Healthcare Provider Details

I. General information

NPI: 1619913886
Provider Name (Legal Business Name): DAN LEO MACUMBER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAN L. MACUMBER D.C.

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 MAIN ST UNITE #5
STURBRIDGE MA
01566-1556
US

IV. Provider business mailing address

42 HILLSIDE DR
STURBRIDGE MA
01566-1536
US

V. Phone/Fax

Practice location:
  • Phone: 508-347-3033
  • Fax: 508-347-3033
Mailing address:
  • Phone: 508-347-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3003
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: