Provider Demographics
NPI:1316442593
Name:MACLEOD, TREVOR I (DC)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:I
Last Name:MACLEOD
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 1:14535 WESTLAKE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7775
Mailing Address - Country:US
Mailing Address - Phone:971-341-4182
Mailing Address - Fax:
Practice Address - Street 1:14535 WESTLAKE DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7775
Practice Address - Country:US
Practice Address - Phone:971-341-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor