Provider Demographics
NPI:1700972775
Name:DRURY, CLIFTON R (DC)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:R
Last Name:DRURY
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 1:103 HAWKINS ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1213
Mailing Address - Country:US
Mailing Address - Phone:502-839-3200
Mailing Address - Fax:502-859-4470
Practice Address - Street 1:103 HAWKINS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1213
Practice Address - Country:US
Practice Address - Phone:502-839-3200
Practice Address - Fax:502-859-4470
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 4015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6053302Medicare ID - Type UnspecifiedMEDICARE ID #
KYT8251Medicare UPIN