=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265645451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARBIN CLYMORE CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2416 W SHAW AVE SUITE 107
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93711-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-439-4439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2416 W SHAW AVE SUITE 107
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93711-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-439-4439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RICHARD RONALD CLYMORE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 559-439-4439
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------