Provider Demographics
NPI:1912213216
Name:BLANCHETTE, CLAYTON JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:JOHN
Last Name:BLANCHETTE
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 1:49 SUMMER ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4528
Mailing Address - Country:US
Mailing Address - Phone:617-858-1278
Mailing Address - Fax:
Practice Address - Street 1:441 STUART ST FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5019
Practice Address - Country:US
Practice Address - Phone:617-247-2300
Practice Address - Fax:617-927-7425
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011685111N00000X
MACH3293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor