MEDICARE: DR. RONALD JOHN LECLAIR D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301002861	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103719	OTHER	MI	MOLINA HEALTHCARE
2	382187798100	OTHER	MI	COMMUNITY CHOICE MI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	950C55006	OTHER	MI	BLUECROSSBLUE SHIELD

General Provider Information

NPI Number	:	1942202247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD JOHN LECLAIR D.C.

Provider Business Mailing Address
First Line	:	432 M 55 W
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9239
Country	:	US
Telephone Number	:	989-362-8991
Fax Number	:	989-362-6237

Provider Business Practice Location Address
First Line	:	432 M 55 W
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9239
Country	:	US
Telephone Number	:	989-362-8991
Fax Number	:	989-362-6237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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