Provider Demographics
NPI:1083750806
Name:JERRY D. MCCLANE, D.C.,P.C.
Entity Type:Organization
Organization Name:JERRY D. MCCLANE, D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCLANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-785-0721
Mailing Address - Street 1:3060 W COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-9347
Mailing Address - Country:US
Mailing Address - Phone:810-785-0721
Mailing Address - Fax:810-789-3678
Practice Address - Street 1:3060 W COLDWATER RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-9347
Practice Address - Country:US
Practice Address - Phone:810-785-0721
Practice Address - Fax:810-789-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM002158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1032760Medicaid
MIT82888Medicare UPIN
MI1032760Medicaid