Provider Demographics
NPI:1396149084
Name:MACIE, JAMES LEONARD (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEONARD
Last Name:MACIE
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 1:16410 BLANCO RD
Mailing Address - Street 2:SUITE NUMBER 5
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1906
Mailing Address - Country:US
Mailing Address - Phone:210-764-0405
Mailing Address - Fax:
Practice Address - Street 1:16410 BLANCO RD
Practice Address - Street 2:SUITE NUMBER 5
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1906
Practice Address - Country:US
Practice Address - Phone:210-764-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12624111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition