Provider Demographics
NPI:1376887992
Name:JUSTICE CLINICAL CONSULTS INC
Entity Type:Organization
Organization Name:JUSTICE CLINICAL CONSULTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:866-289-9084
Mailing Address - Street 1:315 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3114
Mailing Address - Country:US
Mailing Address - Phone:503-635-6246
Mailing Address - Fax:503-635-1405
Practice Address - Street 1:315 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3114
Practice Address - Country:US
Practice Address - Phone:503-635-6246
Practice Address - Fax:503-635-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2651261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR149999Medicare UPIN