=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760584726
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD A CLIFTON DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2006
-----------------------------------------------------
Last Update Date | 01/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 541 PARK ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97355-3313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-451-1290
-----------------------------------------------------
Fax | 541-451-1706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 541 PARK ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97355-3313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-451-1290
-----------------------------------------------------
Fax | 541-451-1706
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 27-2852
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------