Provider Demographics
NPI:1467138107
Name:MCCLURE, WESLEY BLAKE (DC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:BLAKE
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 1:1924 MT GALLANT RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9434
Mailing Address - Country:US
Mailing Address - Phone:803-323-5500
Mailing Address - Fax:803-323-5501
Practice Address - Street 1:1924 MT GALLANT RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9434
Practice Address - Country:US
Practice Address - Phone:803-323-5500
Practice Address - Fax:803-323-5501
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor