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General NPI Number Information
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NPI Number | 1346518602
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Entity Type | Organization
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Legal Business Name | MCCLELLAN CHIROPRACTIC CENTER PA
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 17390 MAIN ST N
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-1763
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Country | US
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Telephone | 850-674-2555
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Fax | 850-674-2576
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Provider Business Mailing Address
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Address Line | 17390 MAIN ST N
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-1763
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Country | US
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Telephone | 850-674-2555
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Fax | 850-674-2576
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. WILLIAM T MCCLELLAN III
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Credential | D.C.
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Telephone | 850-674-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH6803
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License Number State | FL
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