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General NPI Number Information
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NPI Number | 1982811493
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Entity Type | Individual
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Provider Name | JOHN RICHARD CLARK II D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 750 SYCAMORE AVE STE B
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City | VISTA
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State | CA
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Zip | 92083-7912
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Country | US
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Telephone | 760-598-1021
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Fax | 760-598-5584
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Provider Business Mailing Address
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Address Line | 614 NW DELAWARE AVE # A
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City | BEND
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State | OR
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Zip | 97701-3226
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Country | US
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Telephone | 541-389-5849
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Fax | 541-330-8366
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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 | DC 17275
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License Number State | CA
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