Provider Demographics
NPI:1437698537
Name:MCCLENDON, TANYA NICOLE (DC)
Entity Type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:NICOLE
Last Name:MCCLENDON
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 1:1414 W WHEATLAND RD STE 103
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4249
Mailing Address - Country:US
Mailing Address - Phone:972-232-7129
Mailing Address - Fax:
Practice Address - Street 1:1414 W WHEATLAND RD STE 103
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116
Practice Address - Country:US
Practice Address - Phone:972-232-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor