Healthcare Provider Details

I. General information

NPI: 1053637660
Provider Name (Legal Business Name): MCGOUGH DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 CLEVELAND AVE
COLUMBUS OH
43231-2200
US

IV. Provider business mailing address

5980 CLEVELAND AVE
COLUMBUS OH
43231-2200
US

V. Phone/Fax

Practice location:
  • Phone: 614-475-2992
  • Fax: 614-475-2993
Mailing address:
  • Phone: 614-475-2992
  • Fax: 614-475-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3523
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0007
License Number StateOH

VIII. Authorized Official

Name: MICHAEL PATRICK MCGOUGH
Title or Position: OWNER
Credential: D.C.
Phone: 614-475-2992