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NPI Code Detail

MEDICARE: NATHAN CLARK DC

MEDICARE: NATHAN 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
1111N00000XChiropractor34906CA

General Provider Information

NPI Number : 1629684873
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN CLARK DC
Provider Business Mailing Address
First Line : 2310 ARTESIA BLVD
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90278-3114
Country : US
Telephone Number : 310-372-2063
Fax Number :
Provider Business Practice Location Address
First Line : 2310 ARTESIA BLVD
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90278-3114
Country : US
Telephone Number : 310-372-2063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2020
Last Update Date : 01/26/2021

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Directions to “ NATHAN CLARK DC” Practice Location

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