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General NPI Number Information
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NPI Number | 1073049326
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Entity Type | Organization
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Legal Business Name | INSPIRED FAMILY CHIROPRACTIC A CLARK CORPORATION
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 18635 SOLEDAD CANYON RD SUITE 102
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City | SANTA CLARITA
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State | CA
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Zip | 91351-3725
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Country | US
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Telephone | 661-347-6617
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Fax |
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Provider Business Mailing Address
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Address Line | 18635 SOLEDAD CANYON RD SUITE 102
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City | SANTA CLARITA
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State | CA
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Zip | 91351-3725
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Country | US
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Telephone | 661-347-6617
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | NICOLE CASSE CLARK
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Credential | D.C.
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Telephone | 661-347-6617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC33825
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License Number State | CA
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