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General NPI Number Information
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NPI Number | 1154338945
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Entity Type | Individual
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Provider Name | PAUL K CLARK DC
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 725 E COMMERCIAL AVE
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City | LOWELL
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State | IN
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Zip | 46356-2303
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Country | US
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Telephone | 219-696-1910
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Fax | 815-839-9001
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Provider Business Mailing Address
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Address Line | 725 E COMMERCIAL AVE
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City | LOWELL
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State | IN
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Zip | 46356-2303
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Country | US
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Telephone | 219-696-1910
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Fax | 815-839-9001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 08001448A
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License Number State | IN
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