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General NPI Number Information
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NPI Number | 1083750806
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Entity Type | Organization
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Legal Business Name | JERRY D. MCCLANE, D.C.,P.C.
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 3060 W COLDWATER RD
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City | MOUNT MORRIS
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State | MI
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Zip | 48458-9347
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Country | US
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Telephone | 810-785-0721
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Fax | 810-789-3678
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Provider Business Mailing Address
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Address Line | 3060 W COLDWATER RD
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City | MOUNT MORRIS
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State | MI
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Zip | 48458-9347
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Country | US
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Telephone | 810-785-0721
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Fax | 810-789-3678
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JERRY D MCCLANE
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Credential | DC
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Telephone | 810-785-0721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | JM002158
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License Number State | MI
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