Provider Demographics
NPI:1427645175
Name:JEFF CLARK ND LLC
Entity type:Organization
Organization Name:JEFF CLARK ND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-755-1400
Mailing Address - Street 1:15234 SW BURGUNDY ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-1180
Mailing Address - Country:US
Mailing Address - Phone:503-755-1400
Mailing Address - Fax:503-755-1401
Practice Address - Street 1:8555 SW TUALATIN RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8614
Practice Address - Country:US
Practice Address - Phone:503-755-1400
Practice Address - Fax:503-755-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service