Provider Demographics
NPI:1336252998
Name:DAVID J. CLARK, DC PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:DAVID J. CLARK, DC PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-613-7574
Mailing Address - Street 1:1900 OATES DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6862
Mailing Address - Country:US
Mailing Address - Phone:972-613-7574
Mailing Address - Fax:
Practice Address - Street 1:1900 OATES DR
Practice Address - Street 2:SUITE 145
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6862
Practice Address - Country:US
Practice Address - Phone:972-613-7574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00699VMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER