Healthcare Provider Details

I. General information

NPI: 1710338405
Provider Name (Legal Business Name): CLINTON BANEY DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N MAIN ST
WILLIAMSTOWN NJ
08094-1410
US

IV. Provider business mailing address

224 N MAIN ST
WILLIAMSTOWN NJ
08094-1410
US

V. Phone/Fax

Practice location:
  • Phone: 815-988-1393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00734800
License Number StateNJ

VIII. Authorized Official

Name: DR. CLINTON BANEY
Title or Position: OWNER
Credential: DC
Phone: 856-318-4360