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General NPI Number Information
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NPI Number | 1336252998
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Entity Type | Organization
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Legal Business Name | DAVID J. CLARK, DC PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1900 OATES DR SUITE 145
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City | MESQUITE
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State | TX
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Zip | 75150-6862
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Country | US
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Telephone | 972-613-7574
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 OATES DR SUITE 145
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City | MESQUITE
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State | TX
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Zip | 75150-6862
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Country | US
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Telephone | 972-613-7574
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DAVID J CLARK
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Credential | D.C.
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Telephone | 972-613-7574
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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 | 9348
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License Number State | TX
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