Provider Demographics
NPI:1417111204
Name:TLC CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TLC CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:541-582-2323
Mailing Address - Street 1:PO BOX 1257
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537
Mailing Address - Country:US
Mailing Address - Phone:541-582-2323
Mailing Address - Fax:541-582-2419
Practice Address - Street 1:230 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537
Practice Address - Country:US
Practice Address - Phone:541-528-2323
Practice Address - Fax:541-582-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR106940Medicare PIN