Provider Demographics
NPI:1386882314
Name:DACUS, CLINTON KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:KEITH
Last Name:DACUS
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 1:2771 E BROAD ST
Mailing Address - Street 2:STE 211
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9157
Mailing Address - Country:US
Mailing Address - Phone:682-518-6263
Mailing Address - Fax:682-325-3733
Practice Address - Street 1:2771 E BROAD ST
Practice Address - Street 2:STE 211
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9157
Practice Address - Country:US
Practice Address - Phone:682-518-6263
Practice Address - Fax:682-325-3733
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor