Provider Demographics
NPI:1184648743
Name:CLOWES, LAURETTA LYNNE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURETTA
Middle Name:LYNNE
Last Name:CLOWES
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 1:78 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SUSQUEHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18847-2621
Mailing Address - Country:US
Mailing Address - Phone:570-853-3332
Mailing Address - Fax:570-853-3516
Practice Address - Street 1:78 BROAD AVE
Practice Address - Street 2:
Practice Address - City:SUSQUEHANNA
Practice Address - State:PA
Practice Address - Zip Code:18847-2621
Practice Address - Country:US
Practice Address - Phone:570-853-3332
Practice Address - Fax:570-853-3516
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003000L111N00000X
NYX4336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
820362OtherFIRST PRIORITY HEALTH
PA0013015190001Medicaid
PA00456611OtherBLUECROSS/BLUESHIELD
CL456611Medicare ID - Type Unspecified