MEDICARE: RONALD H 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	711	MS

General Provider Information

NPI Number	:	1336317114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD H CLARK DC

Provider Business Mailing Address
First Line	:	4917 POPLAR SPRINGS DRIVE
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305
Country	:	US
Telephone Number	:	601-482-0716
Fax Number	:	601-482-0726

Provider Business Practice Location Address
First Line	:	4917 POPLAR SPRINGS DRIVE
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305
Country	:	US
Telephone Number	:	601-482-0716
Fax Number	:	601-482-0726

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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Directions to “ RONALD H CLARK DC” Practice Location

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