Provider Demographics
NPI:1679762967
Name:MCCLOY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MCCLOY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCLOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-423-2436
Mailing Address - Street 1:913 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:ONAWA
Mailing Address - State:IA
Mailing Address - Zip Code:51040-1631
Mailing Address - Country:US
Mailing Address - Phone:712-423-2436
Mailing Address - Fax:712-423-2361
Practice Address - Street 1:913 IOWA AVE
Practice Address - Street 2:
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-1631
Practice Address - Country:US
Practice Address - Phone:712-423-2436
Practice Address - Fax:712-423-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4667OtherMIDLAND CHOICE
IA0299818Medicaid
IA0299818Medicaid