Healthcare Provider Details

I. General information

NPI: 1861616658
Provider Name (Legal Business Name): COURTNEY ARRON MCCLURE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/08/2007

III. Provider practice location address

11 WARREN DRIVE
KINGSTON OH
45644-0646
US

IV. Provider business mailing address

11 WARREN DRIVE PO BOX 646
KINGSTON OH
45644-0646
US

V. Phone/Fax

Practice location:
  • Phone: 740-642-4154
  • Fax: 740-642-4156
Mailing address:
  • Phone: 740-438-3080
  • Fax: 740-642-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number2739
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: