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General NPI Number Information
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NPI Number | 1386731677
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Entity Type | Individual
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Provider Name | JOHN GREGORY CLARK D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 7461 N 1ST ST STE 103
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City | FRESNO
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State | CA
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Zip | 93720-2850
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Country | US
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Telephone | 559-226-3400
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Fax | 559-226-3963
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Provider Business Mailing Address
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Address Line | 4678 N 1ST ST
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City | FRESNO
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State | CA
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Zip | 93726-0903
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Country | US
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Telephone | 559-226-3400
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Fax | 559-226-3963
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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 | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 17061
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License Number State | CA
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