Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4646 | NC |
N | 111NR0400X | Rehabilitation Chiropractor | 4646 | NC |
N | 111NS0005X | Chiropractic Sports Physician | 4646 | NC |
NPI | 1174975700 |
---|---|
Provider Name | Dr. Clinton Sellers |
First Address | Raleigh, NC 27603-8573 |
Second Address | Raleigh, NC 27609-7755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2016 |
Last Update Date | 03/06/2020 |