Provider Demographics
NPI:1154598985
Name:MACIOCE, ANTHONY JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:MACIOCE
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 1:9479 GARLAND LANE N.
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55311-5840
Mailing Address - Country:US
Mailing Address - Phone:763-494-8787
Mailing Address - Fax:763-494-8841
Practice Address - Street 1:9479 GARLAND LANE N.
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55311-5840
Practice Address - Country:US
Practice Address - Phone:763-494-8787
Practice Address - Fax:763-494-8841
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor