Provider Demographics
NPI:1104941509
Name:MCCLENNY, SHAUN R (DC)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:R
Last Name:MCCLENNY
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:PO BOX 3788
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-3788
Mailing Address - Country:US
Mailing Address - Phone:410-451-3561
Mailing Address - Fax:410-451-2265
Practice Address - Street 1:1625 CROFTON CTR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1318
Practice Address - Country:US
Practice Address - Phone:410-451-3561
Practice Address - Fax:410-451-2265
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03452111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK7710001OtherCAREFIRST XIP
MD260119934OtherTAX ID
MD64671401OtherCAREFIRST RENDERING #