Provider Demographics
NPI:1205895737
Name:CLEM, NATHAN W (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:W
Last Name:CLEM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1631 15TH AVE W
Mailing Address - Street 2:STE 114
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2792
Mailing Address - Country:US
Mailing Address - Phone:425-771-2225
Mailing Address - Fax:425-670-8121
Practice Address - Street 1:1631 15TH AVE W
Practice Address - Street 2:STE 114
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119
Practice Address - Country:US
Practice Address - Phone:206-283-7033
Practice Address - Fax:206-400-7652
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB20580Medicare ID - Type Unspecified
V02346Medicare UPIN