Provider Demographics
NPI:1407379860
Name:CLARK, HUDSON PASS (DC)
Entity type:Individual
Prefix:DR
First Name:HUDSON
Middle Name:PASS
Last Name:CLARK
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 1:15905 SE OATFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-3933
Mailing Address - Country:US
Mailing Address - Phone:035-317-6287
Mailing Address - Fax:
Practice Address - Street 1:7727 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6360
Practice Address - Country:US
Practice Address - Phone:503-490-5647
Practice Address - Fax:503-254-4749
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty