Provider Demographics
NPI:1992790752
Name:CLARK,, MICHAEL L (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
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 1:9404 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7133
Mailing Address - Country:US
Mailing Address - Phone:425-353-8332
Mailing Address - Fax:425-290-7393
Practice Address - Street 1:9404 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7133
Practice Address - Country:US
Practice Address - Phone:425-353-8332
Practice Address - Fax:425-290-7393
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor