Provider Demographics
NPI:1558358515
Name:CLOUGH, WAYNE GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:GARY
Last Name:CLOUGH
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 1:100 ISLINGTON ST
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4263
Mailing Address - Country:US
Mailing Address - Phone:603-436-9229
Mailing Address - Fax:603-430-8458
Practice Address - Street 1:100 ISLINGTON ST
Practice Address - Street 2:SUITE # 7
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4263
Practice Address - Country:US
Practice Address - Phone:603-436-9229
Practice Address - Fax:603-430-8458
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH07206520481A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH8503892OtherCIGNA
NHNA1558OtherHARVARD PILGRIM
NH0508694Y0NH01OtherANTHEM
NHNH8694Medicare PIN
NH8503892OtherCIGNA