Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 150410-1202 | UT |
NPI | 1053408955 |
---|---|
Provider Name | Dr. Gordon Mcclean |
First Address | Provo, UT 84601-2681 |
Second Address | Provo, UT 84601-2681 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |