Provider Demographics
NPI:1588699441
Name:CLINTON, T. RAYMOND (DC)
Entity type:Individual
Prefix:
First Name:T.
Middle Name:RAYMOND
Last Name:CLINTON
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:PO BOX 46
Mailing Address - Street 2:1505 BUSINESS HWY 18-151E
Mailing Address - City:MT. HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572
Mailing Address - Country:US
Mailing Address - Phone:608-437-5585
Mailing Address - Fax:608-437-7041
Practice Address - Street 1:1505 BUSINESS HWY 18-151E
Practice Address - Street 2:
Practice Address - City:MT. HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572
Practice Address - Country:US
Practice Address - Phone:608-437-5585
Practice Address - Fax:608-437-7041
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1272-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT61677Medicare UPIN
WI35795Medicare ID - Type Unspecified