Provider Demographics
NPI:1063609832
Name:MCCLERREN, LEON T (DC)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:T
Last Name:MCCLERREN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4838
Mailing Address - Country:US
Mailing Address - Phone:904-783-0008
Mailing Address - Fax:904-389-5227
Practice Address - Street 1:5222 LENOX AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4838
Practice Address - Country:US
Practice Address - Phone:904-783-0008
Practice Address - Fax:904-389-5227
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55312AMedicare PIN
FLV09160Medicare UPIN