Provider Demographics
NPI:1538376611
Name:CLUNIE, TOM K (DC)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:K
Last Name:CLUNIE
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:P.O. BOX 425
Mailing Address - Street 2:58 TALENT AVENUE
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-0425
Mailing Address - Country:US
Mailing Address - Phone:541-535-3369
Mailing Address - Fax:
Practice Address - Street 1:58 TALENT AVENUE
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540
Practice Address - Country:US
Practice Address - Phone:541-535-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR130061Medicare ID - Type UnspecifiedMEDICARE
ORT05209Medicare UPIN