Provider Demographics
NPI:1912919242
Name:CURRY, CLYDE RAYMOND (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:RAYMOND
Last Name:CURRY
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 E BULLARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-431-0626
Mailing Address - Fax:559-431-2724
Practice Address - Street 1:1706 E BULLARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-431-0626
Practice Address - Fax:559-431-2724
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T04275Medicare UPIN
CADC0112900Medicare ID - Type Unspecified