Provider Demographics
NPI:1912077371
Name:CLEMMONS, JASON RAY (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RAY
Last Name:CLEMMONS
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 1:5817 95TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4750
Mailing Address - Country:US
Mailing Address - Phone:806-783-9130
Mailing Address - Fax:
Practice Address - Street 1:8004 ABBEVILLE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2806
Practice Address - Country:US
Practice Address - Phone:806-794-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J0812OtherBCBS
TX8J0812OtherBCBS