Provider Demographics
NPI:1285869040
Name:MC CHIROPRACTIC
Entity type:Organization
Organization Name:MC CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CACKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-858-3385
Mailing Address - Street 1:1550 BIDDLE RD
Mailing Address - Street 2:STE. D
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4691
Mailing Address - Country:US
Mailing Address - Phone:541-858-3385
Mailing Address - Fax:541-858-6672
Practice Address - Street 1:1550 BIDDLE RD
Practice Address - Street 2:STE. D
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4691
Practice Address - Country:US
Practice Address - Phone:541-858-3385
Practice Address - Fax:541-858-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty