Provider Demographics
NPI:1437295573
Name:MCCLURE, MICHAEL R (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
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 1:5420 LAND O LAKES BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-3401
Mailing Address - Country:US
Mailing Address - Phone:813-996-9800
Mailing Address - Fax:813-996-3323
Practice Address - Street 1:5420 LAND O LAKES BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-3401
Practice Address - Country:US
Practice Address - Phone:813-996-9800
Practice Address - Fax:813-996-3326
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13190111N00000X
PADC009218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001606018OtherHIGHMARK BLUE CROSS SHIEL