Provider Demographics
NPI:1265665129
Name:MCCLURE, KRISTEN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LEE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1610
Mailing Address - Country:US
Mailing Address - Phone:231-547-4691
Mailing Address - Fax:231-547-4745
Practice Address - Street 1:1422 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1610
Practice Address - Country:US
Practice Address - Phone:231-547-4691
Practice Address - Fax:231-547-4745
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1617890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor