Provider Demographics
NPI:1548857121
Name:MCLEOD CHIROPRACTIC
Entity type:Organization
Organization Name:MCLEOD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:DAYLE
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MSACN
Authorized Official - Phone:718-635-2142
Mailing Address - Street 1:149 GLENWOOD AVE SIDE DOOR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4025
Mailing Address - Country:US
Mailing Address - Phone:718-635-2142
Mailing Address - Fax:929-575-4674
Practice Address - Street 1:149 GLENWOOD AVE SIDE DOOR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4025
Practice Address - Country:US
Practice Address - Phone:718-635-2142
Practice Address - Fax:929-575-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty