Provider Demographics
NPI:1073673026
Name:CLAYCOMB, SHAWN A (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:A
Last Name:CLAYCOMB
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 1:405 WATER ST
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-1915
Mailing Address - Country:US
Mailing Address - Phone:814-224-0081
Mailing Address - Fax:
Practice Address - Street 1:405 WATER ST
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1915
Practice Address - Country:US
Practice Address - Phone:804-224-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007297L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA044459Medicare ID - Type UnspecifiedCHIROPRACTOR