Basic Information
Provider Information
NPI: 1912555269
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCLELLAND
FirstName: DANIEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 EMBARCADERO CTR STE 1900
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941113723
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 468 ELLIS ST
Address2:  
City: MOUNTAIN VIEW
State: CA
PostalCode: 940432237
CountryCode: US
TelephoneNumber: 4152910480
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/29/2019
LastUpdateDate: 03/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X33237CAY Chiropractic ProvidersChiropractor 

No ID Information.


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