Provider Demographics
NPI:1477660215
Name:CLUXTON, TALLIE L (DC)
Entity Type:Individual
Prefix:
First Name:TALLIE
Middle Name:L
Last Name:CLUXTON
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 1:215 FOREST PARK CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4916
Mailing Address - Country:US
Mailing Address - Phone:850-215-5657
Mailing Address - Fax:850-215-5658
Practice Address - Street 1:215 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4916
Practice Address - Country:US
Practice Address - Phone:850-215-5657
Practice Address - Fax:850-215-5658
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73011OtherBCBS OF FL PROVIDER #
FL78727743OtherGREENWAVE AETNA PROVIDER
FL78727743OtherGREENWAVE AETNA PROVIDER
FL73011OtherBCBS OF FL PROVIDER #
FL73011ZMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
FL78727743OtherGREENWAVE AETNA PROVIDER