Provider Demographics
NPI:1235295379
Name:MCLEAN, CELESTE (DC)
Entity Type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 BALTIC AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3351
Mailing Address - Country:US
Mailing Address - Phone:757-422-2260
Mailing Address - Fax:757-422-2261
Practice Address - Street 1:1812 BALTIC AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3351
Practice Address - Country:US
Practice Address - Phone:757-422-2260
Practice Address - Fax:757-422-2261
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor