Provider Demographics
NPI:1912926171
Name:CLAWSON, PATRICK S (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:S
Last Name:CLAWSON
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 1:727 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-3314
Mailing Address - Country:US
Mailing Address - Phone:318-927-2320
Mailing Address - Fax:318-927-3090
Practice Address - Street 1:727 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3314
Practice Address - Country:US
Practice Address - Phone:318-927-2320
Practice Address - Fax:318-927-3090
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1953385Medicaid
LA2518AOtherBC/BS
LA1953385Medicaid
LAT20053Medicare UPIN