Provider Demographics
NPI:1104150184
Name:MCGAA, MARY L (DC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:MCGAA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6388 158TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5883
Mailing Address - Country:US
Mailing Address - Phone:952-953-6378
Mailing Address - Fax:
Practice Address - Street 1:14555 S ROBERT TRL
Practice Address - Street 2:SUITE 104
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-3130
Practice Address - Country:US
Practice Address - Phone:952-857-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor