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General NPI Number Information
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NPI Number | 1124123849
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Entity Type | Organization
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Legal Business Name | CLARK CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 418 EAST DIAMOND AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20877-3018
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Country | US
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Telephone | 301-926-1500
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Fax | 301-926-0462
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Provider Business Mailing Address
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Address Line | 418 EAST DIAMOND AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20877-3018
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Country | US
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Telephone | 301-926-1500
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Fax | 301-926-0462
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. STEVEN E CLARK
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Credential | DC
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Telephone | 301-926-1500
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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 | 1464PT
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License Number State | MD
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