Provider Demographics
NPI:1770618852
Name:MCCLAIN CHIROPRACTIC INC
Entity type:Organization
Organization Name:MCCLAIN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-297-2273
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
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:72519-0373
Practice Address - Country:US
Practice Address - Phone:870-297-2273
Practice Address - Fax:870-297-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152317718Medicaid
AR5C710Medicare ID - Type Unspecified
ARU92501Medicare UPIN