Provider Demographics
NPI:1295115558
Name:RICKS MCCLURE CHIROPRACTIC
Entity type:Organization
Organization Name:RICKS MCCLURE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-547-4691
Mailing Address - Street 1:1422 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1610
Mailing Address - Country:US
Mailing Address - Phone:231-547-4691
Mailing Address - Fax:231-547-4745
Practice Address - Street 1:1422 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1610
Practice Address - Country:US
Practice Address - Phone:231-547-4691
Practice Address - Fax:231-547-4745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty