Provider Demographics
NPI:1710338405
Name:CLINTON BANEY DC LLC
Entity Type:Organization
Organization Name:CLINTON BANEY DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-318-4360
Mailing Address - Street 1:507 WILLIAMSTOWN NEW FREEDOM RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:507 WILLIAMSTOWN NEW FREEDOM RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1775
Practice Address - Country:US
Practice Address - Phone:856-318-4360
Practice Address - Fax:856-513-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00734800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty