Provider Demographics
NPI:1730187675
Name:CLIFFORD, LINCOLN O (DC)
Entity type:Individual
Prefix:
First Name:LINCOLN
Middle Name:O
Last Name:CLIFFORD
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 1:2230 N UNIVERSITY PKWY
Mailing Address - Street 2:6B
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1509
Mailing Address - Country:US
Mailing Address - Phone:801-235-9944
Mailing Address - Fax:801-235-9955
Practice Address - Street 1:2230 N UNIVERSITY PKWY
Practice Address - Street 2:6B
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1509
Practice Address - Country:US
Practice Address - Phone:801-235-9944
Practice Address - Fax:801-235-9955
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2751171202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU72103Medicare UPIN
UT000056361Medicare ID - Type Unspecified