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General NPI Number Information
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NPI Number | 1083799555
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Entity Type | Organization
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Legal Business Name | CLANCEY CHIROPRACTIC, PC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 195 S MAIN ST SUITE #1
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City | LONGMONT
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State | CO
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Zip | 80501-5780
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Country | US
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Telephone | 303-651-2060
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Fax | 303-651-9701
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Provider Business Mailing Address
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Address Line | 195 S MAIN ST SUITE #1
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City | LONGMONT
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State | CO
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Zip | 80501-5780
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Country | US
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Telephone | 303-651-2060
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Fax | 303-651-9701
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS A CLANCEY
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Credential | DC
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Telephone | 303-651-2060
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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 | 2390
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License Number State | CO
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