Healthcare Provider Details

I. General information

NPI: 1215062781
Provider Name (Legal Business Name): CLAYTON ELIZABETH SPIVEY L.AC.,M.AC, DIPL.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8342 OLD MONTGOMERY RD
COLUMBIA MD
21045-2640
US

IV. Provider business mailing address

8342 OLD MONTGOMERY RD
COLUMBIA MD
21045-2640
US

V. Phone/Fax

Practice location:
  • Phone: 410-799-5883
  • Fax: 410-799-5886
Mailing address:
  • Phone: 410-799-5883
  • Fax: 410-799-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU-411
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: