Provider Demographics
NPI:1336228345
Name:THOMAS, CLINTON RANDALL (DIP AC, LAC)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:RANDALL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DIP AC, LAC
Other - Prefix:
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Mailing Address - Street 1:12471 SE LINWOOD AVE
Mailing Address - Street 2:E4
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2439
Mailing Address - Country:US
Mailing Address - Phone:503-659-1141
Mailing Address - Fax:503-297-3827
Practice Address - Street 1:9900 SW WILSHIRE
Practice Address - Street 2:190-C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-297-3825
Practice Address - Fax:503-297-3827
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORAC00512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist