Provider Demographics
NPI:1487756185
Name:MCCLURE, DONALD D (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:D
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 1:111 W RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4498
Mailing Address - Country:US
Mailing Address - Phone:630-837-3090
Mailing Address - Fax:630-837-3053
Practice Address - Street 1:111 W RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4498
Practice Address - Country:US
Practice Address - Phone:630-837-3090
Practice Address - Fax:630-837-3053
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210316Medicare Oscar/Certification
ILU51578Medicare UPIN
ILK12243Medicare PIN