Provider Demographics
NPI:1962078279
Name:CLARK CHIROPRACTIC INC
Entity type:Organization
Organization Name:CLARK CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:NEATHERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:425-255-0427
Mailing Address - Street 1:17422 108TH AVE SE #101
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5400
Mailing Address - Country:US
Mailing Address - Phone:425-255-0427
Mailing Address - Fax:425-255-1066
Practice Address - Street 1:17422 108TH AVE SE #101
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5400
Practice Address - Country:US
Practice Address - Phone:425-255-0427
Practice Address - Fax:425-255-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty