Provider Demographics
NPI:1619913886
Name:MACUMBER, DAN LEO (DC)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:LEO
Last Name:MACUMBER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:L
Other - Last Name:MACUMBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:42 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1536
Mailing Address - Country:US
Mailing Address - Phone:508-347-9540
Mailing Address - Fax:
Practice Address - Street 1:113 MAIN ST
Practice Address - Street 2:UNITE #5
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1556
Practice Address - Country:US
Practice Address - Phone:508-347-3033
Practice Address - Fax:508-347-3033
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor