MEDICARE: TIMOTHY 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	5291	NC

General Provider Information

NPI Number	:	1629650502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY CLARK DC

Provider Business Mailing Address
First Line	:	306 MUIRS CHAPEL RD STE A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-6178
Country	:	US
Telephone Number	:	336-852-2222
Fax Number	:	336-852-4844

Provider Business Practice Location Address
First Line	:	306 MUIRS CHAPEL RD STE A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-6178
Country	:	US
Telephone Number	:	336-852-2222
Fax Number	:	336-852-4844

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	03/30/2022

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Directions to “ TIMOTHY CLARK DC” Practice Location

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