Provider Demographics
NPI:1942276217
Name:MCCLAIN, SHAD ASHLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAD
Middle Name:ASHLEY
Last Name:MCCLAIN
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:PO BOX 373
Mailing Address - Street 2:201 HWY 223 S. (JCT 56 & 223)
Mailing Address - City:CALICO ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72519-0373
Mailing Address - Country:US
Mailing Address - Phone:870-297-2273
Mailing Address - Fax:870-297-2274
Practice Address - Street 1:201 HWY 223 (JCT 56 & 223)
Practice Address - Street 2:
Practice Address - City:CALICO ROCK
Practice Address - State:AR
Practice Address - Zip Code:72519
Practice Address - Country:US
Practice Address - Phone:870-297-2273
Practice Address - Fax:870-297-2274
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152317718Medicaid
ARU92501Medicare UPIN
AR5X137Medicare ID - Type Unspecified