Provider Demographics
NPI:1558445452
Name:MCCLENNEN, ANDREW A (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:A
Last Name:MCCLENNEN
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 1:46 CROWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1184
Mailing Address - Country:US
Mailing Address - Phone:508-945-7755
Mailing Address - Fax:508-945-7711
Practice Address - Street 1:46 CROWELL ROAD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633-1184
Practice Address - Country:US
Practice Address - Phone:508-945-7755
Practice Address - Fax:508-945-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY 45281Medicare ID - Type UnspecifiedPROVIDER NUMBER