Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8412 | TX |
NPI | 1003972308 |
---|---|
Provider Name | Dr. John R. Mcclelland |
First Address | Austin, TX 78745-2131 |
Second Address | Austin, TX 78705-3302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8412 | LICENSE (01) | TX |