Provider Demographics
NPI:1871874396
Name:SHOWN, CLYDE L (CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:L
Last Name:SHOWN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5340
Mailing Address - Country:US
Mailing Address - Phone:334-361-0955
Mailing Address - Fax:
Practice Address - Street 1:660 MCQUEEN SMITH RD N STE E
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7559
Practice Address - Country:US
Practice Address - Phone:334-361-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0146Other0146