Provider Demographics
NPI:1912081167
Name:MCCANSE, JAMES RODNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RODNEY
Last Name:MCCANSE
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 1:45648 M 51
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MI
Mailing Address - Zip Code:49045-9038
Mailing Address - Country:US
Mailing Address - Phone:269-423-7034
Mailing Address - Fax:269-423-8817
Practice Address - Street 1:45648 M 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MI
Practice Address - Zip Code:49045-9038
Practice Address - Country:US
Practice Address - Phone:269-423-7034
Practice Address - Fax:269-423-8817
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2040573Medicaid
MI0H00051OtherBLUE CROSS BLUE SHIELD
MI0H00051OtherBLUE CROSS BLUE SHIELD
MI2040573Medicaid
MIT32672Medicare UPIN