Provider Demographics
NPI:1629600697
Name:WELCH, CLAYTON CONNER (DC)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:CONNER
Last Name:WELCH
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 1:1101 STANDIFORD AVE STE A6
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0981
Mailing Address - Country:US
Mailing Address - Phone:209-522-0822
Mailing Address - Fax:209-522-4563
Practice Address - Street 1:1101 STANDIFORD AVE STE A6
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0981
Practice Address - Country:US
Practice Address - Phone:209-522-0822
Practice Address - Fax:209-522-4563
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC34740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor