Provider Demographics
NPI:1821194168
Name:MCCLINTON, GARY WARREN (DC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WARREN
Last Name:MCCLINTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964
Mailing Address - Country:US
Mailing Address - Phone:936-564-8679
Mailing Address - Fax:936-462-9809
Practice Address - Street 1:1923 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964
Practice Address - Country:US
Practice Address - Phone:936-564-8679
Practice Address - Fax:936-462-9809
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603064Medicare ID - Type Unspecified
U14211Medicare UPIN