Provider Demographics
NPI:1962832311
Name:MCCLELLAN, DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:MCCLELLAN
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 1:110 S 4TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058
Mailing Address - Country:US
Mailing Address - Phone:214-477-7626
Mailing Address - Fax:
Practice Address - Street 1:110 S 4TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GUNTER
Practice Address - State:TX
Practice Address - Zip Code:75058
Practice Address - Country:US
Practice Address - Phone:214-477-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor