Healthcare Provider Details

I. General information

NPI: 1316026537
Provider Name (Legal Business Name): CLINTON W VANFLEET JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 HUDSON
LONGVIEW WA
98632
US

IV. Provider business mailing address

1060 HUDSON
LONGVIEW WA
98632
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-2037
  • Fax: 360-423-9320
Mailing address:
  • Phone: 360-423-2037
  • Fax: 360-423-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00002253
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: