Provider Demographics
NPI:1700970266
Name:MCLEOD, TINA M (DC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:CAITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5306 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217
Mailing Address - Country:US
Mailing Address - Phone:414-332-0859
Mailing Address - Fax:414-332-3991
Practice Address - Street 1:5306 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-332-0859
Practice Address - Fax:414-332-3991
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4017-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7611702OtherAETNA
WI38952600Medicaid
WI391555906018OtherCOMPCAREBLUE & BLUE CROSS
WI38952600Medicaid