Provider Demographics
NPI:1396866190
Name:MCCLELLAN, NANCY DIANE (DC DIPL AC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:DIANE
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:DC DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 DANBURY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2151
Mailing Address - Country:US
Mailing Address - Phone:214-692-5555
Mailing Address - Fax:214-279-0150
Practice Address - Street 1:8215 WESTCHESTER DR
Practice Address - Street 2:STE 243
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6103
Practice Address - Country:US
Practice Address - Phone:214-692-5555
Practice Address - Fax:214-692-1424
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor