Provider Demographics
NPI:1881791580
Name:MCLEAN, PHILIP ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANDREW
Last Name:MCLEAN
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 1:1485 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3522
Mailing Address - Country:US
Mailing Address - Phone:207-783-0078
Mailing Address - Fax:207-783-2809
Practice Address - Street 1:1485 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3522
Practice Address - Country:US
Practice Address - Phone:207-783-0078
Practice Address - Fax:207-783-2809
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM6301Medicare PIN
MEU64283Medicare UPIN