Provider Demographics
NPI:1316000870
Name:MACAULAY, JOHN CLARK (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLARK
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 1:403 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1805
Mailing Address - Country:US
Mailing Address - Phone:610-296-5560
Mailing Address - Fax:610-296-5560
Practice Address - Street 1:403 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1805
Practice Address - Country:US
Practice Address - Phone:610-296-5560
Practice Address - Fax:610-296-5560
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002848L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA137672OtherHIGHMARK BLUE SHIELD
4488569OtherAETNA
PA0026867000OtherINDEPENDENCE BC
PA137672FLFMedicare PIN
PA0026867000OtherINDEPENDENCE BC
4488569OtherAETNA
T29491Medicare UPIN