Healthcare Provider Details

I. General information

NPI: 1508165580
Provider Name (Legal Business Name): MACNAUGHTON CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CHESTER STREET
GLEN FALLS NY
12801
US

IV. Provider business mailing address

13 CHESTER STREET
GLEN FALLS NY
12801
US

V. Phone/Fax

Practice location:
  • Phone: 518-223-0331
  • Fax: 518-223-0331
Mailing address:
  • Phone: 518-223-0331
  • Fax: 518-223-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number010161
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number010161
License Number StateNY

VIII. Authorized Official

Name: CHAD MACNAUGHTON
Title or Position: OWNER
Credential: D.C.
Phone: 518-223-0331