MEDICARE: DR. SCOTT DOUGLAS MCCLURE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1996	OH

General Provider Information

NPI Number	:	1346244266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT DOUGLAS MCCLURE D.C.

Provider Business Mailing Address
First Line	:	570 E KREMER HOYING RD
Second Line	:	STE H
City	:	ST HENRY
State	:	OH
Zip	:	45883-9613
Country	:	US
Telephone Number	:	419-678-4873
Fax Number	:	419-678-4873

Provider Business Practice Location Address
First Line	:	570 E KREMER HOYING RD
Second Line	:	STE H
City	:	ST HENRY
State	:	OH
Zip	:	45883-9613
Country	:	US
Telephone Number	:	419-678-4873
Fax Number	:	419-678-4873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/01/2010

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