Provider Demographics
NPI:1013063734
Name:CLEMONS, BRIAN KEITH (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:CLEMONS
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 1:930 MAIN ST
Mailing Address - Street 2:SUITE T-275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-6201
Mailing Address - Country:US
Mailing Address - Phone:713-739-1136
Mailing Address - Fax:713-739-1137
Practice Address - Street 1:930 MAIN ST
Practice Address - Street 2:SUITE T-275
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-6201
Practice Address - Country:US
Practice Address - Phone:713-739-1136
Practice Address - Fax:713-739-8200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor