MEDICARE: DR. TRACI D CLARK DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2876	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073548996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACI D CLARK DC

Provider Business Mailing Address
First Line	:	PO BOX 7353
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804
Country	:	US
Telephone Number	:	252-446-7246
Fax Number	:	252-446-5407

Provider Business Practice Location Address
First Line	:	224 N FAIRVIEW ROAD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27801
Country	:	US
Telephone Number	:	252-446-7246
Fax Number	:	252-446-5407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/14/2007

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Directions to “ DR. TRACI D CLARK DC” Practice Location

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