Provider Demographics
NPI:1053335547
Name:CLEMENT, WILLIAM E (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:CLEMENT
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 1:657 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5596
Mailing Address - Country:US
Mailing Address - Phone:208-552-9886
Mailing Address - Fax:208-552-9843
Practice Address - Street 1:657 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5596
Practice Address - Country:US
Practice Address - Phone:208-552-9886
Practice Address - Fax:208-552-9843
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010153393OtherBLUE SHIELD
IDC4850OtherBLUE CROSS
IDC4850OtherBLUE CROSS
1670286Medicare ID - Type Unspecified