Healthcare Provider Details

I. General information

NPI: 1447416631
Provider Name (Legal Business Name): MCCLAIN SPORTS & WELLNESS INC A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 WILSHIRE BLVD STE 410
LOS ANGELES CA
90048-5606
US

IV. Provider business mailing address

6360 WILSHIRE BLVD STE 410
LOS ANGELES CA
90048-5606
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-1014
  • Fax:
Mailing address:
  • Phone: 323-653-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC24745
License Number StateCA

VIII. Authorized Official

Name: DR. DIONNE K MCCLAIN
Title or Position: CEO/PRESITDENT
Credential: DC
Phone: 323-653-1014