Provider Demographics
NPI:1801100151
Name:CLEMENTS CHIROPRACTIC CENTER, INC
Entity type:Organization
Organization Name:CLEMENTS CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-986-2865
Mailing Address - Street 1:3720 E ANAHEIM ST STE 180
Mailing Address - Street 2:
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 STE 180
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30736111N00000X
CADC16294111N00000X
CALAC11348171100000X
CADC28049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty