Jack J Clark is a Chiropractor in Fort Wayne, Indiana. Jack J Clark practices all healthcare services and medical treatments related to Chiropractor. The NPI Number for Jack J Clark is 1902881014. The last update date is 2010-06-22.
Jack J Clark's current location address is 6015 E State Blvd, Fort Wayne, Indiana. You can contact this provider via phone number 2604861886. The mailing address for Jack J Clark is 6015 E State Blvd, Fort Wayne, Indiana. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jack J Clark |
|---|---|
| Address | 6015 E State Blvd, Fort Wayne, Indiana |
| Phone Number | 2604861886 |
| Fax Number | |
| Sole Proprietor | Y |
| Credentials | D.C. |
NPI Number Detail
| NPI Number | 1902881014 |
|---|---|
| Provider Enumeration Date | 2005-12-12 |
| Last Updated Date | 2010-06-22 |
Provider Mailing Address Detail
| Address | 6015 E State Blvd |
|---|---|
| City | Fort Wayne |
| State | Indiana (IN) |
| Post Code | 468157638 |
| Phone Number | 2604861886 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Chiropractor |
|---|---|
| Taxonomy | 111N00000X |
| Licence No | 08000717A |
|
Definition: A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its inte |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 100289660A | IN | -- | |
| 86699 | IN | BLUE CROSS/BLUE SHIELD |
Post Comment/ Review Below
What is the unique identifier code issued to Jack J Clark by the Centers for Medicare & Medicaid Services?
The Jack J Clark has been assigned the NPI (National Provider Identifier) 1902881014. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete physical address where Jack J Clark is located?
The Jack J Clark is situated at the following address: 6015 E State Blvd, Fort Wayne, IN, 468157638.
What is the area of specialization for Jack J Clark, and what is the corresponding taxonomy classification code for this field?
The specialized field of practice for Jack J Clark is Chiropractor, and the corresponding taxonomy code that categorizes this area of expertise is 111N00000X.
On what date was the 1902881014 assigned to Jack J Clark?
The Jack J Clark was issued its 1902881014 on 2005-12-12, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
As of what date were the Jack J Clark's details last updated?
The information pertaining to the Jack J Clark, including its address, specialty, and other details, was most recently updated on 2010-06-22.
NPI Number: 1528061710
Address: 19 Nh Route 104, Meredith, NH