Provider Demographics
NPI:1265503072
Name:CLARK, CLAYTON LOHIAU (DC)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:LOHIAU
Last Name:CLARK
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 1:2828 THOUSAND OAKS
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-377-3379
Mailing Address - Fax:210-403-3038
Practice Address - Street 1:2828 THOUSAND OAKS
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-377-3379
Practice Address - Fax:210-403-3038
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8097111N00000X, 111NS0005X
133N00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3341OtherBCBS
U72767Medicare UPIN
TX8A3341OtherBCBS