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General NPI Number Information
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NPI Number | 1013929991
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Entity Type | Individual
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Provider Name | NESLY CLERGE DC
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 2041 MARTIN LUTHER KING JR AVE SE SUITE E
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City | WASHINGTON
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State | DC
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Zip | 20020-7024
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Country | US
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Telephone | 202-610-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 6509 WOOD POINTE DR
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City | GLENN DALE
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State | MD
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Zip | 20769-2116
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Country | US
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Telephone | 314-520-4411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 030059
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License Number State | DC
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