Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CH60770180 | WA |
NPI | 1053839597 |
---|---|
Provider Name | Dr. Michael David Clifton |
First Address | Tacoma, WA 98408-1238 |
Second Address | Tacoma, WA 98408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2017 |
Last Update Date | 05/09/2017 |