Healthcare Provider Details

I. General information

NPI: 1457431017
Provider Name (Legal Business Name): CLEMENTS CHIROPRACTIC CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51060 HAYES RD
MACOMB MI
48042-4057
US

IV. Provider business mailing address

51060 HAYES RD
MACOMB MI
48042-4057
US

V. Phone/Fax

Practice location:
  • Phone: 586-781-4314
  • Fax: 586-781-4452
Mailing address:
  • Phone: 586-781-4314
  • Fax: 586-781-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007332
License Number StateMI

VIII. Authorized Official

Name: DEREK M CLEMENTS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 586-781-4314