Healthcare Provider Details

I. General information

NPI: 1174975700
Provider Name (Legal Business Name): CLINTON SELLERS DC, MS, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CLINT SELLERS DC, MS, CCSP

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 BROWNING PL STE 110
RALEIGH NC
27609-6512
US

IV. Provider business mailing address

3948 BROWNING PL STE 110
RALEIGH NC
27609-6512
US

V. Phone/Fax

Practice location:
  • Phone: 919-699-8184
  • Fax: 919-480-2757
Mailing address:
  • Phone: 919-699-8184
  • Fax: 919-480-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4646
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4646
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4646
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: