Healthcare Provider Details

I. General information

NPI: 1710358981
Provider Name (Legal Business Name): CLINTON BANEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
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: 815-988-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104557252
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011201
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00734800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: