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NPI Code Detail

MEDICARE: DR. BETTY JO CLARK DC

MEDICARE:  DR. BETTY JO 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
1111N00000XChiropractor1597AR

General Provider Information

NPI Number : 1275581902
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETTY JO CLARK DC
Provider Business Mailing Address
First Line : 8000 DALLAS ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4277
Country : US
Telephone Number : 479-484-0805
Fax Number : 479-452-1475
Provider Business Practice Location Address
First Line : 8000 DALLAS ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4277
Country : US
Telephone Number : 479-484-0805
Fax Number : 479-452-1475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 06/19/2012

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Directions to “ DR. BETTY JO CLARK DC” Practice Location

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