Provider Demographics
NPI:1699976639
Name:MCCAULEY CHIROPRACTIC PC
Entity type:Organization
Organization Name:MCCAULEY CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-650-5525
Mailing Address - Street 1:115 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2032
Mailing Address - Country:US
Mailing Address - Phone:248-650-5525
Mailing Address - Fax:248-650-5544
Practice Address - Street 1:115 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2032
Practice Address - Country:US
Practice Address - Phone:248-650-5525
Practice Address - Fax:248-650-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0910334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F32999OtherBLUE CROSS
MIP31530001Medicare ID - Type Unspecified