Provider Demographics
NPI:1083799555
Name:CLANCEY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CLANCEY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-651-2060
Mailing Address - Street 1:195 S MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5780
Mailing Address - Country:US
Mailing Address - Phone:303-651-2060
Mailing Address - Fax:303-651-9701
Practice Address - Street 1:195 S MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5780
Practice Address - Country:US
Practice Address - Phone:303-651-2060
Practice Address - Fax:303-651-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO471528Medicare ID - Type Unspecified