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General NPI Number Information
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NPI Number | 1518396126
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PAIN CLINIC OF PORTLAND
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 6105 SW MACADAM AVE
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City | PORTLAND
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State | OR
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Zip | 97239-3640
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Country | US
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Telephone | 503-244-3389
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Fax |
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Provider Business Mailing Address
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Address Line | 6105 SW MACADAM AVE
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City | PORTLAND
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State | OR
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Zip | 97239-3640
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Country | US
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Telephone | 503-244-3389
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEAN ALLEN CLARK
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Credential | D.C.
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Telephone | 503-244-3389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 1856
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License Number State | OR
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