MEDICARE: CLARK CHIROPRACTIC INC

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	917	OH

General Provider Information

NPI Number	:	1982744264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	12 W WENGER RD STE 6
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2755
Country	:	US
Telephone Number	:	937-836-1288
Fax Number	:	937-832-1251

Provider Business Practice Location Address
First Line	:	12 W WENGER RD STE 6
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2755
Country	:	US
Telephone Number	:	937-836-1288
Fax Number	:	937-832-1251

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ROBERT W CLARK
Credential	:	DC
Telephone Number	:	937-836-1288

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	02/21/2018

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