=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336292523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK EUGENE MCADOO D.C.,
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 476 RICHLAND AVE
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45701-3748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-592-6362
-----------------------------------------------------
Fax | 740-592-4611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3525 PLEASANT HILL RD
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45701-9572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-592-6374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NI0900X
-----------------------------------------------------
Taxonomy Name | Internist Chiropractor
-----------------------------------------------------
License Number | 1516
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------