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General NPI Number Information
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NPI Number | 1639482185
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Entity Type | Organization
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Legal Business Name | ST HENRY CHIROPRACTIC
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 570 E KREMER HOYING RD SUITE H
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City | SAINT HENRY
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State | OH
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Zip | 45883-9613
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Country | US
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Telephone | 419-678-4873
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Fax | 419-678-4873
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Provider Business Mailing Address
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Address Line | 570 E KREMER HOYING RD SUITE H
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City | SAINT HENRY
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State | OH
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Zip | 45883-9613
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Country | US
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Telephone | 419-678-4873
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Fax | 419-678-4873
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT D MCCLURE
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Credential | D.C.
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Telephone | 419-678-4873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1996
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License Number State | OH
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