Provider Demographics
NPI:1912932252
Name:CLARY, PATRICK SHAWN (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:SHAWN
Last Name:CLARY
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 1:815 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5923
Mailing Address - Country:US
Mailing Address - Phone:870-246-2902
Mailing Address - Fax:870-246-3706
Practice Address - Street 1:815 CLINTON ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5923
Practice Address - Country:US
Practice Address - Phone:870-246-2902
Practice Address - Fax:870-246-3706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S834Medicare UPIN