Provider Demographics
NPI:1518166560
Name:CLAYTON CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:CLAYTON CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROCCOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-553-5505
Mailing Address - Street 1:8838 US HIGHWAY 70 W
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4822
Mailing Address - Country:US
Mailing Address - Phone:919-553-5505
Mailing Address - Fax:919-553-9909
Practice Address - Street 1:8838 US HIGHWAY 70 W
Practice Address - Street 2:SUITE 700
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4822
Practice Address - Country:US
Practice Address - Phone:919-553-5505
Practice Address - Fax:919-553-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0838JOtherBCBS
U77023OtherUPIN
NC890838JMedicaid