Provider Demographics
NPI:1083734446
Name:MCLEOD EASTPOINTE CHIROPRACTIC, PC
Entity type:Organization
Organization Name:MCLEOD EASTPOINTE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-774-8492
Mailing Address - Street 1:21349 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3217
Mailing Address - Country:US
Mailing Address - Phone:586-774-8492
Mailing Address - Fax:
Practice Address - Street 1:21349 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3217
Practice Address - Country:US
Practice Address - Phone:586-774-8492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E05248OtherBLUE CROSS MI
MI2693066Medicaid
MI0Q25026Medicare ID - Type Unspecified