Healthcare Provider Details

I. General information

NPI: 1912081167
Provider Name (Legal Business Name): JAMES RODNEY MCCANSE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45648 M 51
DECATUR MI
49045-9038
US

IV. Provider business mailing address

45648 M 51
DECATUR MI
49045-9038
US

V. Phone/Fax

Practice location:
  • Phone: 269-423-7034
  • Fax: 269-423-8817
Mailing address:
  • Phone: 269-423-7034
  • Fax: 269-423-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301002769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: