MEDICARE: STEPHEN MCLEAN DC

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	SM004284	MI

General Provider Information

NPI Number	:	1821162538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN MCLEAN DC

Provider Business Mailing Address
First Line	:	1210 N MAPLE RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-2842
Country	:	US
Telephone Number	:	734-668-6110
Fax Number	:	734-668-6117

Provider Business Practice Location Address
First Line	:	1210 N MAPLE RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-2842
Country	:	US
Telephone Number	:	734-668-6110
Fax Number	:	734-668-6117

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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