Provider Demographics
NPI:1053394346
Name:MCCLELLAN, LESLIE M (DC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:M
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E PARKWAY DR STE C
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2266
Mailing Address - Country:US
Mailing Address - Phone:479-219-5030
Mailing Address - Fax:479-219-5434
Practice Address - Street 1:2600 E PARKWAY DR STE C
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2266
Practice Address - Country:US
Practice Address - Phone:479-219-5030
Practice Address - Fax:479-219-5434
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148107718Medicaid
AR5W611OtherBLUE CROSS BLUE SHEILD
AR5G130OtherBLUE CROSS BLUE SHEILD
AR665689OtherUNITED HEALTHCARE