Provider Demographics
NPI:1104046945
Name:MCCLAREN, JOHN WILLIAM (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:MCCLAREN
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Gender:M
Credentials:DC, DACNB
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Mailing Address - Street 1:12040 MCDERMOTT PLZ
Mailing Address - Street 2:STE 320
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2354
Mailing Address - Country:US
Mailing Address - Phone:402-597-2869
Mailing Address - Fax:402-597-2536
Practice Address - Street 1:12040 MCDERMOTT PLZ
Practice Address - Street 2:STE 320
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2354
Practice Address - Country:US
Practice Address - Phone:402-597-2869
Practice Address - Fax:402-597-2536
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2016-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE1269111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084486100Medicaid
NE99512OtherBLUE CROSS BLUE SHIELD ID
NE47084486100Medicaid
NE274708Medicare PIN