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NPI Code Detail

MEDICARE: DR. MICHAEL PATRICK CLARK SR. D.C.

MEDICARE: DR. MICHAEL PATRICK CLARK SR. 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
1111N00000XChiropractorDC003464-LPA

General Provider Information

NPI Number : 1578645768
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL PATRICK CLARK SR. D.C.
Provider Business Mailing Address
First Line : 214 FALCONHURST DR N
Second Line :
City : PITTSBURGH
State : PA
Zip : 15238-2628
Country : US
Telephone Number : 412-826-8805
Fax Number : 412-486-1552
Provider Business Practice Location Address
First Line : 633 MOUNT ROYAL BLVD
Second Line :
City : PITTSBURGH
State : PA
Zip : 15223-1225
Country : US
Telephone Number : 412-486-3355
Fax Number : 412-486-3355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 07/08/2007

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