Provider Demographics
NPI:1386724177
Name:CLANCEY, DOUGLAS ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:CLANCEY
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 1:195 S MAIN ST
Mailing Address - Street 2:SUITE# 1
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5780
Mailing Address - Country:US
Mailing Address - Phone:303-651-2060
Mailing Address - Fax:303-651-9701
Practice Address - Street 1:195 S MAIN ST
Practice Address - Street 2:SUITE# 1
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5780
Practice Address - Country:US
Practice Address - Phone:303-651-2060
Practice Address - Fax:303-651-9701
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCL47893OtherBLUE CROSS/ BLUE SHIELD
COCL47893OtherBLUE CROSS/ BLUE SHIELD
COT60627Medicare UPIN