Provider Demographics
NPI:1053612655
Name:CAVELL CLUM, DANA LORRAINE (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:LORRAINE
Last Name:CAVELL CLUM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 MEDFORD AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1336
Mailing Address - Country:US
Mailing Address - Phone:631-569-5476
Mailing Address - Fax:631-569-5478
Practice Address - Street 1:585 MEDFORD AVE STE 10
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1336
Practice Address - Country:US
Practice Address - Phone:631-569-5476
Practice Address - Fax:631-569-5478
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010114-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor