Provider Demographics
NPI:1316495393
Name:CLAXON MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:CLAXON MANAGEMENT GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CLAXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-475-0000
Mailing Address - Street 1:186 INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1787
Mailing Address - Country:US
Mailing Address - Phone:606-475-0000
Mailing Address - Fax:
Practice Address - Street 1:186 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1787
Practice Address - Country:US
Practice Address - Phone:606-475-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty