Provider Demographics
NPI:1013208289
Name:CLAS, CAROL ANN (DC, LIC AC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:CLAS
Suffix:
Gender:F
Credentials:DC, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3513
Mailing Address - Country:US
Mailing Address - Phone:518-456-4700
Mailing Address - Fax:
Practice Address - Street 1:1529 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3513
Practice Address - Country:US
Practice Address - Phone:518-456-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX00876-1111N00000X
NY001124-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist