Provider Demographics
NPI:1558445346
Name:MACLEOD, ROBERT DARRYL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DARRYL
Last Name:MACLEOD
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 1:5140 EDENHURST RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1217
Mailing Address - Country:US
Mailing Address - Phone:470-554-2805
Mailing Address - Fax:
Practice Address - Street 1:5140 EDENHURST RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-1217
Practice Address - Country:US
Practice Address - Phone:470-554-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3271111N00000X
ZZNO ISSUED LICENSE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
U9194Medicare UPIN