Provider Demographics
NPI:1669747879
Name:MCCLELLAN FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:MCCLELLAN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-238-0673
Mailing Address - Street 1:PO BOX 4098
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36204
Mailing Address - Country:US
Mailing Address - Phone:256-238-0673
Mailing Address - Fax:256-238-0675
Practice Address - Street 1:1021 US HWY 431
Practice Address - Street 2:SUITE 12
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36206
Practice Address - Country:US
Practice Address - Phone:256-238-0673
Practice Address - Fax:256-238-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1669747879OtherMEDICARE TYPE 2 NPI
AL051554302Medicare UPIN