Provider Demographics
NPI:1699773861
Name:CLARK, SHARON LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LYNN
Last Name:CLARK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1532
Mailing Address - Country:US
Mailing Address - Phone:207-989-3700
Mailing Address - Fax:207-989-9833
Practice Address - Street 1:220 STATE ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1532
Practice Address - Country:US
Practice Address - Phone:207-989-3700
Practice Address - Fax:207-989-9833
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME3123011OtherAETNA
ME034276OtherBCBS
MEC0527OtherBCBS
ME7370445OtherAETNA
U68648Medicare UPIN
ME034276OtherBCBS