Provider Demographics
NPI:1124463237
Name:MACKAY, DOUGLAS JESSE (ND)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JESSE
Last Name:MACKAY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 L ST NW
Mailing Address - Street 2:STE 510
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5104
Mailing Address - Country:US
Mailing Address - Phone:603-969-4470
Mailing Address - Fax:202-204-7701
Practice Address - Street 1:1828 L ST NW
Practice Address - Street 2:STE 510
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5104
Practice Address - Country:US
Practice Address - Phone:603-969-4470
Practice Address - Fax:202-204-7701
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH37175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath