Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1963 | CO |
N | 111NS0005X | Chiropractic Sports Physician | CHIA-700 | ID |
NPI | 1023170479 |
---|---|
Provider Name | Dr. Daniel J Mcclure |
First Address | Durango, CO 81303 |
Second Address | Durango, CO 81303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T60550 | (02) | CO |