=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225286966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAY CHIROPRACTIC CLINIC, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2008
-----------------------------------------------------
Last Update Date | 09/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1105 S MISSION ST
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48858-3914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-506-2559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1105 S MISSION ST
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48858-3914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-506-2559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID MICHAEL CLAY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 989-506-2559
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301009441
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------