Provider Demographics
NPI:1831831049
Name:SUTTON, CLARENCE ROBERT III (DC)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:ROBERT
Last Name:SUTTON
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MICKEY
Other - Middle Name:R
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:19248 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9422
Mailing Address - Country:US
Mailing Address - Phone:734-558-6419
Mailing Address - Fax:
Practice Address - Street 1:19248 INKSTER RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-9422
Practice Address - Country:US
Practice Address - Phone:734-558-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor