Provider Demographics
NPI:1912906926
Name:MCLANE, RODNEY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:DAVID
Last Name:MCLANE
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 1:1600 GRATIOT BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1145
Mailing Address - Country:US
Mailing Address - Phone:810-364-8200
Mailing Address - Fax:810-364-8201
Practice Address - Street 1:1600 GRATIOT BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1145
Practice Address - Country:US
Practice Address - Phone:810-364-8200
Practice Address - Fax:810-364-8201
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRM006910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2587930Medicaid
MI2587930Medicaid