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General NPI Number Information
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NPI Number | 1801079256
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Entity Type | Individual
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Provider Name | DR. MICHAEL PARK MCCRACKEN
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Gender | Male
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 6521 HIGHWAY 69 S SUITE N
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City | TUSCALOOSA
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State | AL
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Zip | 35405-3964
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Country | US
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Telephone | 205-345-5035
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 MAYBERRY LANDING DR
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City | NORTHPORT
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State | AL
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Zip | 35473-1918
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Country | US
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Telephone | 214-886-1862
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2276
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License Number State | AL
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