Healthcare Provider Details

I. General information

NPI: 1700412343
Provider Name (Legal Business Name): CLAYTON CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 YOUNGSTOWN LOCKPORT RD
RANSOMVILLE NY
14131-9668
US

IV. Provider business mailing address

PO BOX 252
RANSOMVILLE NY
14131-0252
US

V. Phone/Fax

Practice location:
  • Phone: 716-791-1280
  • Fax: 716-791-1017
Mailing address:
  • Phone: 716-791-1280
  • Fax: 716-791-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE W CLAYTON
Title or Position: PRESIDENT
Credential: DC
Phone: 716-946-2799