Provider Demographics
NPI:1285795534
Name:MACAULAY, GRAHAM ALLISTER (DC)
Entity type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:ALLISTER
Last Name:MACAULAY
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 1:1102 BIRD AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-1700
Mailing Address - Country:US
Mailing Address - Phone:408-275-1900
Mailing Address - Fax:408-275-1964
Practice Address - Street 1:10 HIGH ST UNIT H
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3144
Practice Address - Country:US
Practice Address - Phone:401-515-5552
Practice Address - Fax:408-275-1964
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0601076OtherTAX ID
CA77-0601076OtherTAX ID
CAU59045Medicare UPIN