Individual provider · Type 1 NPI
Jack J. Clark, DC
Chiropractor · Fort Wayne, IN
NPI number
1902881014
Active
Practice location
6015 E State Blvd
Fort Wayne, IN 46815-7638
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Chiropractor Primary | 111N00000X | 08000717A (IN) |
Chiropractor: 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 interrelationship with other body systems.
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About NPI 1902881014
Jack J. Clark, DC's National Provider Identifier is 1902881014, issued on Dec 12, 2005. The primary taxonomy on file is Chiropractor (111N00000X), and the practice location is in Fort Wayne, IN. The record was last updated on Jun 22, 2010.