Provider Demographics
NPI:1275698771
Name:CLIFTON, RICHARD CLARENCE III (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLARENCE
Last Name:CLIFTON
Suffix:III
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 1:929 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582-3953
Mailing Address - Country:US
Mailing Address - Phone:256-356-2225
Mailing Address - Fax:256-356-2225
Practice Address - Street 1:929 4TH ST NW
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582-3953
Practice Address - Country:US
Practice Address - Phone:256-356-2225
Practice Address - Fax:256-356-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000026222Medicare ID - Type Unspecified