Healthcare Provider Details

I. General information

NPI: 1083664619
Provider Name (Legal Business Name): BRANDON W MCCLELLAND DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 WEST MARION RD
MOUNT GILEAD OH
43338-1056
US

IV. Provider business mailing address

644 WEST MARION RD
MOUNT GILEAD OH
43338-1056
US

V. Phone/Fax

Practice location:
  • Phone: 419-946-5921
  • Fax: 419-946-5665
Mailing address:
  • Phone: 419-946-5921
  • Fax: 419-946-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3391
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: