Provider Demographics
NPI:1477624583
Name:MCCLAIN, DIONNE K (DC)
Entity Type:Individual
Prefix:DR
First Name:DIONNE
Middle Name:K
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 WILSHIRE BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5601
Mailing Address - Country:US
Mailing Address - Phone:323-653-1014
Mailing Address - Fax:323-653-3745
Practice Address - Street 1:6360 WILSHIRE BLVD STE 410
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5601
Practice Address - Country:US
Practice Address - Phone:323-653-1014
Practice Address - Fax:323-653-3745
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU69160Medicare ID - Type Unspecified