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General NPI Number Information
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NPI Number | 1629177340
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Entity Type | Organization
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Legal Business Name | DANA E. CLARK D.C. INC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 11110 OHIO AVE STE 108
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City | LOS ANGELES
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State | CA
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Zip | 90025-6345
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Country | US
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Telephone | 310-473-7130
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Fax | 310-473-5077
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Provider Business Mailing Address
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Address Line | 11110 OHIO AVE STE 108
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City | LOS ANGELES
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State | CA
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Zip | 90025-6345
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Country | US
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Telephone | 310-473-7130
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Fax | 310-473-5077
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DANA ELMORE CLARK
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Credential | DC
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Telephone | 310-473-7130
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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 | DC28616
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License Number State | CA
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