Provider Demographics
NPI:1013907039
Name:CLEMENTS, COREY GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:GARY
Last Name:CLEMENTS
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 1:3720 E ANAHEIM ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4085
Mailing Address - Country:US
Mailing Address - Phone:562-986-2865
Mailing Address - Fax:562-684-4400
Practice Address - Street 1:3720 E ANAHEIM ST
Practice Address - Street 2:SUITE 180
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4085
Practice Address - Country:US
Practice Address - Phone:562-986-2865
Practice Address - Fax:562-684-4400
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28049Medicare ID - Type Unspecified