Provider Demographics
NPI:1396791273
Name:CLANCEY, ALISSA A (DC)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:A
Last Name:CLANCEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S RURAL RD
Mailing Address - Street 2:SUITE 4N
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2435
Mailing Address - Country:US
Mailing Address - Phone:480-394-0440
Mailing Address - Fax:480-394-0441
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG. 1A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-912-0440
Practice Address - Fax:609-912-1908
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00611100111N00000X
AZ7836111N00000X
AZ4526111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU96056Medicare UPIN
NJ071400R28Medicare ID - Type Unspecified