Provider Demographics
NPI:1245368240
Name:MCCLANAHAN, JAY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:LEE
Last Name:MCCLANAHAN
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 1:642 CROSS LANES DR
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1163
Mailing Address - Country:US
Mailing Address - Phone:304-776-1520
Mailing Address - Fax:304-776-1521
Practice Address - Street 1:642 CROSS LANES DR
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1163
Practice Address - Country:US
Practice Address - Phone:304-776-1520
Practice Address - Fax:304-776-1521
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002674Medicaid
WV7509681OtherAETNA
WV1060823OtherAMERICAN SPECIALTY HEALTH
WV306672OtherCARELINK
WV91087OtherUNICARE
WVAS40510400001OtherCIGNA HEALTHCARE
WV7509681OtherAETNA