Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 10094 | CO |
NPI | 1356607691 |
---|---|
Provider Name | Lisa Jean Clayton |
First Address | Broomfield, CO 80020-5788 |
Second Address | Broomfield, CO 80020-5788 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 11/04/2012 |