Provider Demographics
NPI:1235288044
Name:CLEMENS, LINDA LU (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LU
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:LU
Other - Last Name:BECKEL, PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 GARDNER RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1531
Mailing Address - Country:US
Mailing Address - Phone:360-757-6117
Mailing Address - Fax:
Practice Address - Street 1:312 GARDNER RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1531
Practice Address - Country:US
Practice Address - Phone:360-757-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA52010OtherSTATE WORKERS COMP
WAU52786Medicare UPIN