MEDICARE: DR. LESLIE ELLEN MCCLELLAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1745	AL

General Provider Information

NPI Number	:	1558426650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ELLEN MCCLELLAN D.C.

Provider Business Mailing Address
First Line	:	3731 RAINBOW DR
Second Line	:	STE A
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6367
Country	:	US
Telephone Number	:	256-442-1441
Fax Number	:	256-442-3938

Provider Business Practice Location Address
First Line	:	3731 RAINBOW DR
Second Line	:	STE A
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6307
Country	:	US
Telephone Number	:	256-442-1441
Fax Number	:	256-442-3938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	02/14/2020

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