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General NPI Number Information
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NPI Number | 1407379860
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Entity Type | Individual
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Provider Name | HUDSON PASS CLARK DC
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Gender | Male
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 7727 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97213-6360
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Country | US
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Telephone | 503-490-5647
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Fax | 503-254-4749
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Provider Business Mailing Address
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Address Line | 15905 SE OATFIELD RD
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City | MILWAUKIE
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State | OR
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Zip | 97267-3933
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Country | US
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Telephone | 35-317-6287
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5833
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License Number State | OR
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