Provider Demographics
NPI:1023129194
Name:RONALD A CLIFTON, DC, PC
Entity type:Organization
Organization Name:RONALD A CLIFTON, DC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-451-1290
Mailing Address - Street 1:541 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-3313
Mailing Address - Country:US
Mailing Address - Phone:541-451-1290
Mailing Address - Fax:541-451-1706
Practice Address - Street 1:541 PARK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3313
Practice Address - Country:US
Practice Address - Phone:541-451-1290
Practice Address - Fax:541-451-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========OtherTAX ID NUMBER
OR=========OtherTAX ID NUMBER
ORU46754Medicare UPIN