=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124463237
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOUGLAS JESSE MACKAY N.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2013
-----------------------------------------------------
Last Update Date | 05/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1828 L ST NW STE 510
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20036-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-969-4470
-----------------------------------------------------
Fax | 202-204-7701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1828 L ST NW STE 510
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20036-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-969-4470
-----------------------------------------------------
Fax | 202-204-7701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 37
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------