Provider Demographics
NPI:1427243849
Name:CLAYTON CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:CLAYTON CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-621-1668
Mailing Address - Street 1:533 26TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2459
Mailing Address - Country:US
Mailing Address - Phone:801-621-1668
Mailing Address - Fax:801-621-1670
Practice Address - Street 1:533 26TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2465
Practice Address - Country:US
Practice Address - Phone:801-621-1668
Practice Address - Fax:801-621-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT169368-1202302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT48897Medicare UPIN