MEDICARE: BETTY M CLAYTON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	DC17064	CA

General Provider Information

NPI Number	:	1336243534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY M CLAYTON DC

Provider Business Mailing Address
First Line	:	300 S BEACH BLVD
Second Line	:	SUITE J
City	:	LA HABRA
State	:	CA
Zip	:	90631-5164
Country	:	US
Telephone Number	:	562-694-5552
Fax Number	:	562-694-3003

Provider Business Practice Location Address
First Line	:	300 S BEACH BLVD
Second Line	:	SUITE J
City	:	LA HABRA
State	:	CA
Zip	:	90631-5164
Country	:	US
Telephone Number	:	562-694-5552
Fax Number	:	562-694-3003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	05/06/2008

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