Provider Demographics
NPI:1528374162
Name:CLAVELL, SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:CLAVELL
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 1:1324 GLEN CEDARS DR
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7607
Mailing Address - Country:US
Mailing Address - Phone:404-791-5025
Mailing Address - Fax:
Practice Address - Street 1:2615 E WEST CONNECTOR
Practice Address - Street 2:STE.108
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6848
Practice Address - Country:US
Practice Address - Phone:770-943-1425
Practice Address - Fax:770-943-1452
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor