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General NPI Number Information
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NPI Number | 1699132753
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Entity Type | Organization
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Legal Business Name | MCCLINTOCK CHIROPRACTIC
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 1159 E LAKETON AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-6024
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Country | US
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Telephone | 231-726-6355
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Fax |
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Provider Business Mailing Address
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Address Line | 1159 E LAKETON AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-6024
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Country | US
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Telephone | 231-726-6355
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN ALAN MCCLINTOCK
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Credential | D.C.
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Telephone | 641-895-5816
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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 | 2301010393
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License Number State | MI
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