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General NPI Number Information
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NPI Number | 1407164353
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Entity Type | Individual
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Provider Name | JILL M CLARK D.C.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 401 W ONTARIO ST SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60654-6957
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Country | US
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Telephone | 312-943-3484
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Fax |
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Provider Business Mailing Address
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Address Line | 1444 W OHIO ST # 3F
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City | CHICAGO
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State | IL
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Zip | 60642-7436
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Country | US
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Telephone | 563-370-7626
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.011762
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 007265
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License Number State | IA
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