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General NPI Number Information
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NPI Number | 1710025200
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Entity Type | Organization
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Legal Business Name | CLARK CHIROPRACTIC CENTER, INC.
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 4639 MOUNTAIN RD
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City | PASADENA
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State | MD
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Zip | 21122-5455
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Country | US
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Telephone | 443-637-4936
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Fax | 443-637-4946
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Provider Business Mailing Address
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Address Line | 4639 MOUNTAIN RD
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City | PASADENA
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State | MD
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Zip | 21122-5455
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Country | US
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Telephone | 443-637-4936
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Fax | 443-637-4946
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Authorized Official
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Title or Position | CEO
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Name | DR. STEVEN E. CLARK
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Credential | D.C.
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Telephone | 443-637-4936
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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 | 1464PT
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License Number State | MD
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