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General NPI Number Information
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NPI Number | 1376801639
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Entity Type | Organization
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Legal Business Name | THOMAS R. CLARK, D.C., P.A.
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 2418 SW 9TH AVE
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City | AMARILLO
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State | TX
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Zip | 79106-6620
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Country | US
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Telephone | 806-372-3361
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Fax | 806-372-3955
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Provider Business Mailing Address
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Address Line | 2418 SW 9TH AVE
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City | AMARILLO
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State | TX
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Zip | 79106-6620
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Country | US
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Telephone | 806-372-3361
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Fax | 806-372-3955
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS ROY CLARK
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Credential |
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Telephone | 806-372-3361
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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 | 11827
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License Number State | TX
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