Individual
MS. LESLIE M MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
2600 E PARKWAY DR STE C, RUSSELLVILLE, AR 72802-2266
(479) 219-5030
(479) 219-5434
Mailing address
2600 E PARKWAY DR STE C, RUSSELLVILLE, AR 72802-2266
(479) 219-5030
(479) 219-5434
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1581
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148107718
—
AR
01
—
5G130
BLUE CROSS BLUE SHEILD
AR
01
—
5W611
BLUE CROSS BLUE SHEILD
AR
01
—
665689
UNITED HEALTHCARE
AR
Enumeration date
11/21/2005
Last updated
10/01/2020
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