Healthcare Provider Details

I. General information

NPI: 1295170561
Provider Name (Legal Business Name): CLAYTON CHIROPRACTIC MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST SUITE 240
SAINT LOUIS MO
63122-7356
US

IV. Provider business mailing address

1099 MILWAUKEE ST SUITE 240
SAINT LOUIS MO
63122-7356
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-1502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5509
License Number StateMO

VIII. Authorized Official

Name: CLAYTON D SKAGGS
Title or Position: OWNER
Credential: DC
Phone: 314-822-1502