=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396828356
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL SCOTT MCCLELLAN DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 02/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1021 US HIGHWAY 431 SUITE 12
-----------------------------------------------------
City | ANNISTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36206-1970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-238-0673
-----------------------------------------------------
Fax | 256-238-0675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4098
-----------------------------------------------------
City | ANNISTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36204-4098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-238-0673
-----------------------------------------------------
Fax | 256-238-0675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1441
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------