Provider Demographics
NPI:1306230149
Name:CLEARY, ERIN SUZANNE (DC, MAOM, BS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:SUZANNE
Last Name:CLEARY
Suffix:
Gender:F
Credentials:DC, MAOM, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RANCH ROAD 620 S
Mailing Address - Street 2:SUITE C-209
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5615
Mailing Address - Country:US
Mailing Address - Phone:512-993-8949
Mailing Address - Fax:
Practice Address - Street 1:900 RANCH ROAD 620 S
Practice Address - Street 2:SUITE C-209
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5615
Practice Address - Country:US
Practice Address - Phone:512-993-8949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor