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General NPI Number Information
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NPI Number | 1508191305
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Entity Type | Organization
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Legal Business Name | MCLEOD SHELBY CHIROPRACTIC PC
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Dates
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Enumeration Date | 10/12/2009
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 53505 VAN DYKE AVE
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-1861
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Country | US
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Telephone | 586-992-8888
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Fax | 586-992-8889
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Provider Business Mailing Address
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Address Line | 53505 VAN DYKE AVE
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-1861
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Country | US
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Telephone | 586-992-8888
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Fax | 586-992-8889
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS A MCLEOD
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Credential | DC
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Telephone | 586-992-8888
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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 | 2301005579
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License Number State | MI
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