Provider Demographics
NPI:1760584726
Name:CLIFTON, RONALD A (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:CLIFTON
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 1:541 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-3313
Mailing Address - Country:US
Mailing Address - Phone:541-451-1290
Mailing Address - Fax:541-451-1706
Practice Address - Street 1:541 PARK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3313
Practice Address - Country:US
Practice Address - Phone:541-451-1290
Practice Address - Fax:541-451-1706
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
R108176Medicare PIN
U46754Medicare UPIN