Provider Demographics
NPI:1487733713
Name:MACH, PAUL C (DN)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:MACH
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 SPAULDING ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7318
Mailing Address - Country:US
Mailing Address - Phone:217-638-6224
Mailing Address - Fax:
Practice Address - Street 1:3129 SPAULDING ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7318
Practice Address - Country:US
Practice Address - Phone:217-638-6224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000180172P00000X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL181-000180OtherSTATE LICENSE