Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 38MC00611100 | NJ |
N | 111N00000X | Chiropractor | 7836 | AZ |
N | 111NR0400X | Rehabilitation Chiropractor | 4526 | AZ |
NPI | 1396791273 |
---|---|
Provider Name | Dr. Alissa A Clancey |
First Address | Tempe, AZ 85282-2435 |
Second Address | Lawrenceville, NJ 08648-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U96056 | (02) | NJ |