Provider Demographics
NPI:1558426650
Name:MCCLELLAN, LESLIE ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ELLEN
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:ELLEN
Other - Last Name:SCERBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3731 RAINBOW DR
Mailing Address - Street 2:STE A
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-6367
Mailing Address - Country:US
Mailing Address - Phone:256-442-1441
Mailing Address - Fax:256-442-3938
Practice Address - Street 1:3731 RAINBOW DR
Practice Address - Street 2:STE A
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6307
Practice Address - Country:US
Practice Address - Phone:256-442-1441
Practice Address - Fax:256-442-3938
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000034215Medicare ID - Type Unspecified
ALU63159Medicare UPIN