Provider Demographics
NPI:1710358981
Name:BANEY, CLINTON (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:
Last Name:BANEY
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 1:224 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1410
Mailing Address - Country:US
Mailing Address - Phone:815-988-1393
Mailing Address - Fax:
Practice Address - Street 1:801 HUGHES DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-584-1313
Practice Address - Fax:609-584-1972
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011201111N00000X
VA0104557252111N00000X
NJ38MC00734800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor