Healthcare Provider Details

I. General information

NPI: 1962863753
Provider Name (Legal Business Name): ADELE JANE CLARK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23100 PACIFIC HWY S STE 201
DES MOINES WA
98198-7281
US

IV. Provider business mailing address

23100 PACIFIC HWY S STE 201
DES MOINES WA
98198-7281
US

V. Phone/Fax

Practice location:
  • Phone: 206-824-9500
  • Fax: 206-824-9654
Mailing address:
  • Phone: 206-824-9500
  • Fax: 206-824-9654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60619222
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: