Provider Demographics
NPI:1275509200
Name:MCCLELLAN, GEORGE B (DC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:B
Last Name:MCCLELLAN
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 1:520 E FOOTHILL BL
Mailing Address - Street 2:#A
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-399-9696
Mailing Address - Fax:909-399-0065
Practice Address - Street 1:520 E FOOTHILL BL
Practice Address - Street 2:#A
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-399-9696
Practice Address - Fax:909-399-0065
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T04776Medicare UPIN
DC12472Medicare ID - Type Unspecified