MEDICARE: DR. MICHAEL T CLARK D. C.

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	11809510184A	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19394	OTHER	NH	MATTHEW THORNTON HEALTH P
2	7802 OUT OF STATE	OTHER	NJ	ANTHEM NJ
3	80705	OTHER	NH	GREAT WEST HC
4	AA44982	OTHER	NH	HPHC
5	63665	OTHER		GREAT WEST NA
6	0508438Y0NH01	OTHER	NH	ANTHEM
7	453731	OTHER	NH	AETNA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	3228	OTHER	NH	CIGNA

General Provider Information

NPI Number	:	1275596041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL T CLARK D. C.

Provider Business Mailing Address
First Line	:	23 CHARLES ST
Second Line	:
City	:	ROCHESTER
State	:	NH
Zip	:	03867-2926
Country	:	US
Telephone Number	:	603-332-8989
Fax Number	:	603-332-8989

Provider Business Practice Location Address
First Line	:	23 CHARLES ST
Second Line	:
City	:	ROCHESTER
State	:	NH
Zip	:	03867-2926
Country	:	US
Telephone Number	:	603-332-8989
Fax Number	:	603-332-8989

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	01/29/2016

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