Provider Demographics
NPI:1619208436
Name:CLINTON, ELAINE LAVERNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:LAVERNE
Last Name:CLINTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26251 HIGHWAY 82
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-3802
Mailing Address - Country:US
Mailing Address - Phone:918-456-6400
Mailing Address - Fax:918-456-6404
Practice Address - Street 1:26251 HIGHWAY 82
Practice Address - Street 2:SUITE 2
Practice Address - City:PARK HILL
Practice Address - State:OK
Practice Address - Zip Code:74451-3802
Practice Address - Country:US
Practice Address - Phone:918-456-6400
Practice Address - Fax:918-456-6404
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor