Provider Demographics
NPI:1235284787
Name:MCCLELLAN CHIROPRACTIC CENTER, PSC
Entity Type:Organization
Organization Name:MCCLELLAN CHIROPRACTIC CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DALLAS
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-623-3780
Mailing Address - Street 1:1140 BARNES MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8730
Mailing Address - Country:US
Mailing Address - Phone:859-623-3780
Mailing Address - Fax:859-623-8377
Practice Address - Street 1:1140 BARNES MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8730
Practice Address - Country:US
Practice Address - Phone:859-623-3780
Practice Address - Fax:859-623-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5833098OtherAETNA
KY6700325OtherCIGNA HEALTHCARE
KY85000669Medicaid
KY000000271734OtherANTHEM
KYP00030494OtherRAILROAD RETIREMENT BOARD
KYP00030494OtherRAILROAD RETIREMENT BOARD
KY0750901Medicare ID - Type Unspecified