Provider Demographics
NPI:1649226531
Name:MCLEOD, SCOTT GORDON (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GORDON
Last Name:MCLEOD
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 1:48073 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3258
Mailing Address - Country:US
Mailing Address - Phone:586-739-6262
Mailing Address - Fax:586-739-4540
Practice Address - Street 1:48073 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-3258
Practice Address - Country:US
Practice Address - Phone:586-739-6262
Practice Address - Fax:586-739-4540
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E001880OtherBLUE CROSS BLUE SHIELD
MI5274511OtherAETNA
MI4789694Medicaid
MI4789694Medicaid
MIP36940001Medicare PIN