Provider Demographics
NPI:1023170479
Name:MCCLURE, DANIEL J (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 -A S CAMINO DEL RIO
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303
Mailing Address - Country:US
Mailing Address - Phone:970-259-1450
Mailing Address - Fax:970-259-1471
Practice Address - Street 1:523 -A S CAMINO DEL RIO
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303
Practice Address - Country:US
Practice Address - Phone:970-259-1450
Practice Address - Fax:970-259-1471
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1963111NS0005X
IDCHIA-700111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC17613Medicare ID - Type UnspecifiedMEDICARE NUMBER
COT60550Medicare UPIN