Provider Demographics
NPI:1861616658
Name:MCCLURE, COURTNEY ARRON (DC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ARRON
Last Name:MCCLURE
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 1:11 WARREN DRIVE
Mailing Address - Street 2:PO BOX 646
Mailing Address - City:KINGSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45644-0646
Mailing Address - Country:US
Mailing Address - Phone:740-438-3080
Mailing Address - Fax:740-642-4156
Practice Address - Street 1:11 WARREN DRIVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OH
Practice Address - Zip Code:45644-0646
Practice Address - Country:US
Practice Address - Phone:740-642-4154
Practice Address - Fax:740-642-4156
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-08-08
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-08
Provider Licenses
StateLicense IDTaxonomies
OH2739111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22000000162917OtherABSC
OH4497404OtherUNITED HEALTHCARE INSUR
OH2450629OtherAETNA
OH2160870Medicaid
OH4497404OtherUNITED HEALTHCARE INSUR