Provider Demographics
NPI:1487052783
Name:MCCANSE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:MCCANSE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCANSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-423-7034
Mailing Address - Street 1:45648 M 51
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MI
Mailing Address - Zip Code:49045-9038
Mailing Address - Country:US
Mailing Address - Phone:269-423-7034
Mailing Address - Fax:269-423-8817
Practice Address - Street 1:45648 M 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MI
Practice Address - Zip Code:49045-9038
Practice Address - Country:US
Practice Address - Phone:269-423-7034
Practice Address - Fax:269-423-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2040573Medicaid
MIMI3553Medicare PIN
MIT32672Medicare UPIN