Provider Demographics
NPI:1538136726
Name:COURT, JOHN CLYDE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLYDE
Last Name:COURT
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 1:121 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1727
Mailing Address - Country:US
Mailing Address - Phone:724-458-5022
Mailing Address - Fax:724-458-4977
Practice Address - Street 1:121 NORTH ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1727
Practice Address - Country:US
Practice Address - Phone:724-458-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDC242111N00000X
TNDC181111N00000X
PADC1689L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006346580001Medicaid
PA0006346580001Medicaid