Provider Demographics
NPI:1255335667
Name:MCCLOY, BRIAN R (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:MCCLOY
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 1:913 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:ONAWA
Mailing Address - State:IA
Mailing Address - Zip Code:51040-1631
Mailing Address - Country:US
Mailing Address - Phone:712-423-2436
Mailing Address - Fax:712-423-2361
Practice Address - Street 1:913 IOWA AVE
Practice Address - Street 2:
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-1631
Practice Address - Country:US
Practice Address - Phone:712-423-2436
Practice Address - Fax:712-423-2361
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA26394OtherBCBS
IA2263947Medicaid
IA26394OtherBCBS
IAT01414Medicare UPIN