Basic Information
| Provider Information | |||||||||
| NPI: | 1871791004 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MACEWEN CHIROPRACTIC OFFICE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 WILKENS DR | ||||||||
| Address2: | |||||||||
| City: | PLAINVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027622257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086994482 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 WILKENS DR | ||||||||
| Address2: | |||||||||
| City: | PLAINVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027622257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086994482 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 07/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | MACEWEN | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5086994482 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH507 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.