Provider Demographics
NPI:1154173094
Name:EARL, MACY (DC)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:EARL
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 1:61539 SE JENNIFER LN UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3892
Mailing Address - Country:US
Mailing Address - Phone:306-471-7619
Mailing Address - Fax:
Practice Address - Street 1:155 SW CENTURY DR STE 111
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1657
Practice Address - Country:US
Practice Address - Phone:541-797-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor