Healthcare Provider Details

I. General information

NPI: 1184964876
Provider Name (Legal Business Name): CLARK CHIROPRACTIC CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28800 W 8 MILE RD STE 5858
FARMINGTON HILLS MI
48336-5906
US

IV. Provider business mailing address

28800 W 8 MILE RD STE 5858
FARMINGTON HILLS MI
48336-5906
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-0440
  • Fax: 248-471-6270
Mailing address:
  • Phone: 248-471-0440
  • Fax: 248-471-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES ALVIN CLARK
Title or Position: OWNER
Credential: DC
Phone: 248-471-0440