Provider Demographics
NPI:1285849588
Name:CLEMENT, DAVID (DC)
Entity Type:Individual
Prefix:MISS
First Name:DAVID
Middle Name:
Last Name:CLEMENT
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 1:11895 COPPER MINE DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7729
Mailing Address - Country:US
Mailing Address - Phone:801-302-1342
Mailing Address - Fax:
Practice Address - Street 1:1684 REUNION AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4609
Practice Address - Country:US
Practice Address - Phone:801-446-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT365993-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor