Provider Demographics
NPI:1174981674
Name:MCCLINTOCK, BENJAMIN ALAN (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALAN
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 E LAKETON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-6024
Mailing Address - Country:US
Mailing Address - Phone:231-726-6355
Mailing Address - Fax:
Practice Address - Street 1:1159 E LAKETON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-6024
Practice Address - Country:US
Practice Address - Phone:231-726-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty