Provider Demographics
NPI:1942045794
Name:LEGO, CLAYTON (DC)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:
Last Name:LEGO
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 1:41 LINCOLN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2219
Mailing Address - Country:US
Mailing Address - Phone:563-581-3265
Mailing Address - Fax:
Practice Address - Street 1:521 WESTBURY DR STE 1
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2727
Practice Address - Country:US
Practice Address - Phone:319-338-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA127167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor