Provider Demographics
NPI:1407940679
Name:BOONE, KARL CLAYTON (DC)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:CLAYTON
Last Name:BOONE
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 1:121 S KANAWHA ST
Mailing Address - Street 2:
Mailing Address - City:BUCKLANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201
Mailing Address - Country:US
Mailing Address - Phone:304-472-7161
Mailing Address - Fax:304-472-2294
Practice Address - Street 1:121 S KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201
Practice Address - Country:US
Practice Address - Phone:304-472-7161
Practice Address - Fax:304-472-2294
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1069589OtherWORKERS COMP
WV013145000Medicaid
WV000143921OtherBCBS
9359971Medicare ID - Type Unspecified
WV1069589OtherWORKERS COMP