Provider Demographics
NPI:1942360409
Name:JOHN CB MCDONALD CLINIC PC
Entity Type:Organization
Organization Name:JOHN CB MCDONALD CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CB
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-925-3232
Mailing Address - Street 1:763 E NAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-6119
Mailing Address - Country:US
Mailing Address - Phone:269-925-3232
Mailing Address - Fax:269-925-9489
Practice Address - Street 1:763 E NAPIER AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6119
Practice Address - Country:US
Practice Address - Phone:269-925-3232
Practice Address - Fax:269-925-9489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95 0A150360OtherBLUE CROSS BLUE SHIELD
MI4347941Medicaid
MI95 0A150360OtherBLUE CROSS BLUE SHIELD
MI4347941Medicaid