Provider Demographics
NPI:1639482185
Name:ST HENRY CHIROPRACTIC
Entity Type:Organization
Organization Name:ST HENRY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-678-4873
Mailing Address - Street 1:570 E KREMER HOYING RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SAINT HENRY
Mailing Address - State:OH
Mailing Address - Zip Code:45883-9613
Mailing Address - Country:US
Mailing Address - Phone:419-678-4873
Mailing Address - Fax:419-678-4873
Practice Address - Street 1:570 E KREMER HOYING RD
Practice Address - Street 2:SUITE H
Practice Address - City:SAINT HENRY
Practice Address - State:OH
Practice Address - Zip Code:45883-9613
Practice Address - Country:US
Practice Address - Phone:419-678-4873
Practice Address - Fax:419-678-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346244266OtherNPI FOR PROVIDER
OHU43982OtherUPIN
OHU43982OtherUPIN