Provider Demographics
NPI:1578800207
Name:MEEKS, CLIFFORD C (LAC, MPH)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:C
Last Name:MEEKS
Suffix:
Gender:M
Credentials:LAC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 N ALBINA AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1800
Mailing Address - Country:US
Mailing Address - Phone:912-596-6150
Mailing Address - Fax:
Practice Address - Street 1:2330 NW FLANDERS ST
Practice Address - Street 2:SUITE #101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3442
Practice Address - Country:US
Practice Address - Phone:503-701-8766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153795171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist