Provider Demographics
NPI:1588156509
Name:CLARK, ANDREW JEFFREY (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JEFFREY
Last Name:CLARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 W 110TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1509
Mailing Address - Country:US
Mailing Address - Phone:913-340-9900
Mailing Address - Fax:913-340-9449
Practice Address - Street 1:6355 W 110TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1509
Practice Address - Country:US
Practice Address - Phone:913-340-9900
Practice Address - Fax:913-340-9449
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor