Provider Demographics
NPI:1376321711
Name:CLIFFORD, CLINT P (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:P
Last Name:CLIFFORD
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 1:1022 N 4TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3100
Mailing Address - Country:US
Mailing Address - Phone:208-446-8737
Mailing Address - Fax:
Practice Address - Street 1:1022 N 4TH ST STE 102
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3100
Practice Address - Country:US
Practice Address - Phone:208-446-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor