Provider Demographics
NPI:1518246032
Name:ELLISON, CLAYTON SAMUEL (DC)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:SAMUEL
Last Name:ELLISON
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 1:3057 LORNA RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4514
Mailing Address - Country:US
Mailing Address - Phone:205-822-1414
Mailing Address - Fax:205-822-1499
Practice Address - Street 1:3057 LORNA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-4514
Practice Address - Country:US
Practice Address - Phone:205-822-1414
Practice Address - Fax:205-822-1499
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor