Provider Demographics
NPI:1003443359
Name:HENRY A MCCLEARY DC LLC
Entity Type:Organization
Organization Name:HENRY A MCCLEARY DC LLC
Other - Org Name:DR MACS WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-463-4644
Mailing Address - Street 1:2241C TACKETTS MILL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3028
Mailing Address - Country:US
Mailing Address - Phone:703-463-4644
Mailing Address - Fax:855-552-3776
Practice Address - Street 1:2241C TACKETTS MILL DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3028
Practice Address - Country:US
Practice Address - Phone:703-463-4644
Practice Address - Fax:855-552-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain