Provider Demographics
NPI:1124749189
Name:MACALINO, JONATHAN (DC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MACALINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 DEUSSEN LN
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-1552
Mailing Address - Country:US
Mailing Address - Phone:281-814-6825
Mailing Address - Fax:
Practice Address - Street 1:822 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2026
Practice Address - Country:US
Practice Address - Phone:281-814-6825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor