=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548857121
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCLEOD CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2020
-----------------------------------------------------
Last Update Date | 12/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 149 GLENWOOD AVE SIDE DOOR
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10301-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-635-2142
-----------------------------------------------------
Fax | 929-575-4674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 149 GLENWOOD AVE SIDE DOOR
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10301-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-635-2142
-----------------------------------------------------
Fax | 929-575-4674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/OWNER
-----------------------------------------------------
Name | DR. ADRIENNE DAYLE MCLEOD
-----------------------------------------------------
Credential | DC, MSACN
-----------------------------------------------------
Telephone | 718-635-2142
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------