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General NPI Number Information
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NPI Number | 1477783769
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Entity Type | Organization
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Legal Business Name | CLARK FAMILY CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 351 PASCOE BLVD. STE 106
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City | BOWLING GREEN
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State | KY
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Zip | 42104
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Country | US
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Telephone | 270-843-1930
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Fax | 860-530-9599
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Provider Business Mailing Address
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Address Line | 351 PASCOE BLVD. SUITE 106
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City | BOWLING GREEN
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State | KY
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Zip | 42104
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Country | US
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Telephone | 270-843-1930
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Fax | 866-530-9599
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMIE C CLARK
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Credential | D.C.
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Telephone | 270-843-1930
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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 | 4742
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License Number State | KY
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