Provider Demographics
NPI:1083664619
Name:MCCLELLAND, BRANDON W (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:W
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 WEST MARION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1056
Mailing Address - Country:US
Mailing Address - Phone:419-946-5921
Mailing Address - Fax:419-946-5665
Practice Address - Street 1:644 WEST MARION RD
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1056
Practice Address - Country:US
Practice Address - Phone:419-946-5921
Practice Address - Fax:419-946-5665
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2384825Medicaid
OH2384825Medicaid