Provider Demographics
NPI:1700412343
Name:CLAYTON CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CLAYTON CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-946-2799
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:RANSOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14131-0252
Mailing Address - Country:US
Mailing Address - Phone:716-791-1280
Mailing Address - Fax:716-791-1017
Practice Address - Street 1:2551 YOUNGSTOWN LOCKPORT RD
Practice Address - Street 2:
Practice Address - City:RANSOMVILLE
Practice Address - State:NY
Practice Address - Zip Code:14131-9668
Practice Address - Country:US
Practice Address - Phone:716-791-1280
Practice Address - Fax:716-791-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty