Provider Demographics
NPI:1871791004
Name:MACEWEN CHIROPRACTIC OFFICE, INC
Entity type:Organization
Organization Name:MACEWEN CHIROPRACTIC OFFICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-699-4482
Mailing Address - Street 1:3 WILKENS DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2257
Mailing Address - Country:US
Mailing Address - Phone:508-699-4482
Mailing Address - Fax:
Practice Address - Street 1:3 WILKENS DR
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2257
Practice Address - Country:US
Practice Address - Phone:508-699-4482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35350Medicare PIN
MA58123Medicare UPIN