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General NPI Number Information
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NPI Number | 1366417487
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Entity Type | Individual
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Provider Name | JEFFREY PAUL CLARK D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 9633 MARKET PLACE SUITE #103
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City | LAKE STEVENS
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State | WA
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Zip | 98258
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Country | US
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Telephone | 425-335-0300
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Fax | 425-335-0302
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Provider Business Mailing Address
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Address Line | 9633 MARKET PLACE SUITE #103
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City | LAKE STEVENS
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State | WA
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Zip | 98258
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Country | US
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Telephone | 425-335-0300
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Fax | 425-335-0302
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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 | CH00002638
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License Number State | WA
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