Provider Demographics
NPI:1932114659
Name:MARK D MCCLURE INC
Entity Type:Organization
Organization Name:MARK D MCCLURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-423-7855
Mailing Address - Street 1:182 N BREIEL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3802
Mailing Address - Country:US
Mailing Address - Phone:513-423-7855
Mailing Address - Fax:513-422-4103
Practice Address - Street 1:182 N BREIEL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3802
Practice Address - Country:US
Practice Address - Phone:513-423-7855
Practice Address - Fax:513-422-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0950958Medicaid
OH0950958Medicaid
OH9261791Medicare PIN