Provider Demographics
NPI:1053477844
Name:MCCLELLAN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MCCLELLAN CHIROPRACTIC CLINIC
Other - Org Name:MCCLELLAN FAMILY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-442-1441
Mailing Address - Street 1:3731 RAINBOW DR STE A
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-6367
Mailing Address - Country:US
Mailing Address - Phone:256-442-1441
Mailing Address - Fax:256-442-3938
Practice Address - Street 1:3731 RAINBOW DR
Practice Address - Street 2:STE A
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6307
Practice Address - Country:US
Practice Address - Phone:256-442-1441
Practice Address - Fax:256-442-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH056Medicare ID - Type Unspecified