Provider Demographics
NPI:1972004877
Name:MCCLINTOCK, DAVID J
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NW WALL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-3200
Mailing Address - Country:US
Mailing Address - Phone:541-389-4321
Mailing Address - Fax:541-389-4420
Practice Address - Street 1:55 NW WALL ST STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3200
Practice Address - Country:US
Practice Address - Phone:541-389-4321
Practice Address - Fax:541-389-4420
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor