Provider Demographics
NPI:1043211139
Name:CLEMENSON, CARMEN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MARIE
Last Name:CLEMENSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 BARRINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9043
Mailing Address - Country:US
Mailing Address - Phone:319-377-1043
Mailing Address - Fax:319-377-8180
Practice Address - Street 1:960 BARRINGTON PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-9043
Practice Address - Country:US
Practice Address - Phone:319-377-1043
Practice Address - Fax:319-377-8180
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0154971Medicaid
U51899Medicare UPIN
IA58764Medicare ID - Type Unspecified