Provider Demographics
NPI:1871696971
Name:CLEMENT, TERRENCE L II (DC)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:L
Last Name:CLEMENT
Suffix:II
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:PO BOX 1257
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-1257
Mailing Address - Country:US
Mailing Address - Phone:541-582-2323
Mailing Address - Fax:541-582-2419
Practice Address - Street 1:230 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-1257
Practice Address - Country:US
Practice Address - Phone:541-582-2323
Practice Address - Fax:541-582-2419
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
106940Medicare ID - Type Unspecified