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General NPI Number Information
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NPI Number | 1427645175
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Entity Type | Organization
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Legal Business Name | JEFF CLARK ND LLC
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 8555 SW TUALATIN RD
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City | TUALATIN
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State | OR
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Zip | 97062-8614
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Country | US
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Telephone | 503-755-1400
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Fax | 503-755-1401
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Provider Business Mailing Address
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Address Line | 15234 SW BURGUNDY ST
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City | TIGARD
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State | OR
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Zip | 97224-1180
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Country | US
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Telephone | 503-755-1400
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Fax | 503-755-1401
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFF CLARK
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Credential | ND
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Telephone | 503-755-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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