MEDICARE: DR. CATHERINE J MACULAN DACBSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	038007201	IL

General Provider Information

NPI Number	:	1700882347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE J MACULAN DACBSP

Provider Business Mailing Address
First Line	:	403 S MULFORD RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2509
Country	:	US
Telephone Number	:	815-965-3212
Fax Number	:	815-880-0424

Provider Business Practice Location Address
First Line	:	403 S MULFORD RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2509
Country	:	US
Telephone Number	:	815-965-3212
Fax Number	:	815-880-0424

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/11/2025

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