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General NPI Number Information
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NPI Number | 1386013852
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Entity Type | Individual
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Provider Name | ANDREW PHILLIP CLARK L.AC. LMT
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Gender | Male
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 251 CENTRAL AVE
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City | DOVER
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State | NH
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Zip | 03820-4188
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Country | US
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Telephone | 917-771-7163
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Fax |
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Provider Business Mailing Address
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Address Line | 17 SNOWS CT
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City | DOVER
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State | NH
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Zip | 03820-3307
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Country | US
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Telephone | 917-771-7163
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 005636-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 279
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License Number State | NH
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