Provider Demographics
NPI:1598927402
Name:SULLWOLD, CLAYTON RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:RICHARD
Last Name:SULLWOLD
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 1:925 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6545
Mailing Address - Country:US
Mailing Address - Phone:970-385-0321
Mailing Address - Fax:970-385-0281
Practice Address - Street 1:925 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6545
Practice Address - Country:US
Practice Address - Phone:970-385-0321
Practice Address - Fax:970-385-0281
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6110111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition