Provider Demographics
NPI:1215337191
Name:CLANCY, SEAN (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:CLANCY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 DEER PARK AVE
Mailing Address - Street 2:STE A
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3326
Mailing Address - Country:US
Mailing Address - Phone:631-254-0155
Mailing Address - Fax:631-254-0157
Practice Address - Street 1:133 E 58TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1236
Practice Address - Country:US
Practice Address - Phone:212-371-2000
Practice Address - Fax:212-371-2250
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012542-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor