Healthcare Provider Details

I. General information

NPI: 1801100151
Provider Name (Legal Business Name): CLEMENTS CHIROPRACTIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

3720 E ANAHEIM ST STE 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 TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30736
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16294
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC11348
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC28049
License Number StateCA

VIII. Authorized Official

Name: DR. COREY GARY CLEMENTS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 562-986-2865