Provider Demographics
NPI:1457422560
Name:MCCLURE, PATRICK VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:VINCENT
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 1:40258 HIGHWAY 41
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-8844
Mailing Address - Country:US
Mailing Address - Phone:559-641-7400
Mailing Address - Fax:559-641-7401
Practice Address - Street 1:40258 HIGHWAY 41
Practice Address - Street 2:SUITE B
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-8844
Practice Address - Country:US
Practice Address - Phone:559-641-7400
Practice Address - Fax:559-641-7401
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11981111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0119810Medicare ID - Type Unspecified