Provider Demographics
NPI:1902890098
Name:MCCLEERY CHIROPRACTIC HEALTH CENTRE PC
Entity Type:Organization
Organization Name:MCCLEERY CHIROPRACTIC HEALTH CENTRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCLEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-389-7103
Mailing Address - Street 1:404 NE GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4608
Mailing Address - Country:US
Mailing Address - Phone:541-389-7103
Mailing Address - Fax:541-389-1173
Practice Address - Street 1:404 NE GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4608
Practice Address - Country:US
Practice Address - Phone:541-389-7103
Practice Address - Fax:541-389-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005054001OtherREGENCE BLUE CROSS ID
ORR71758Medicare ID - Type UnspecifiedPHYSICIAN ID
ORR71757Medicare ID - Type UnspecifiedCORPORATE PROVIDER ID
ORT67893Medicare UPIN
OR005054001OtherREGENCE BLUE CROSS ID