Healthcare Provider Details

I. General information

NPI: 1013907039
Provider Name (Legal Business Name): COREY GARY CLEMENTS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 E ANAHEIM ST SUITE 180
LONG BEACH CA
90804-4085
US

IV. Provider business mailing address

3720 E ANAHEIM ST SUITE 180
LONG BEACH CA
90804-4085
US

V. Phone/Fax

Practice location:
  • Phone: 562-986-2865
  • Fax: 562-684-4400
Mailing address:
  • Phone: 562-986-2865
  • Fax: 562-684-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC28049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: