Provider Demographics
NPI:1285850545
Name:CLEMENS, RICHARD DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DEAN
Last Name:CLEMENS
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 1:312 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:360-757-7171
Practice Address - Street 1:ABSOLUTE CHIROPRACTIC
Practice Address - Street 2:312 GARDNER RD.
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1531
Practice Address - Country:US
Practice Address - Phone:360-757-7463
Practice Address - Fax:360-757-7171
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACHOOOO3175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA145489OtherL&I
4824CLOtherREGENCE BLUE SHIELD