Provider Demographics
NPI:1992093843
Name:MCLANE & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:MCLANE & ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-364-8200
Mailing Address - Street 1:1600 GRATIOT BLVD.
Mailing Address - Street 2:STE 6
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1145
Mailing Address - Country:US
Mailing Address - Phone:810-364-8200
Mailing Address - Fax:810-364-8201
Practice Address - Street 1:1600 GRATIOT BLVD.
Practice Address - Street 2:STE 6
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1145
Practice Address - Country:US
Practice Address - Phone:810-364-8200
Practice Address - Fax:810-364-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRM006910111N00000X
MILC009754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OG45040Medicare PIN