Provider Demographics
NPI:1093864506
Name:JANSSEN, CLIFFORD (DC)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:JANSSEN
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 1:1114 N OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3514
Mailing Address - Country:US
Mailing Address - Phone:561-835-0115
Mailing Address - Fax:561-835-0164
Practice Address - Street 1:1114 N OLIVE AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3514
Practice Address - Country:US
Practice Address - Phone:561-835-0115
Practice Address - Fax:561-835-0164
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor