Provider Demographics
NPI:1639197916
Name:MCCLENNY, JACQUELINE JOY (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JOY
Last Name:MCCLENNY
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 1:4870 LONG BEACH RD SE # 1
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8713
Mailing Address - Country:US
Mailing Address - Phone:910-454-4041
Mailing Address - Fax:910-454-4044
Practice Address - Street 1:1635 N HOWE ST
Practice Address - Street 2:# JK
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8372
Practice Address - Country:US
Practice Address - Phone:910-454-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor