Provider Demographics
NPI:1427494178
Name:CLARKE CHIROPRACTIC AND WELLNESS, LLC
Entity type:Organization
Organization Name:CLARKE CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-322-9551
Mailing Address - Street 1:806 MYSTIC DR # D207
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-5329
Mailing Address - Country:US
Mailing Address - Phone:850-322-9551
Mailing Address - Fax:
Practice Address - Street 1:1019 HARVIN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3286
Practice Address - Country:US
Practice Address - Phone:321-848-0987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty