Provider Demographics
NPI:1043249519
Name:CLARK, STEPHEN NED (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NED
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 1:9100 SILVERDALE WAY
Mailing Address - Street 2:CLARK CHIROPRACTIC NECK & BACK
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8389
Mailing Address - Country:US
Mailing Address - Phone:360-692-1178
Mailing Address - Fax:360-692-1210
Practice Address - Street 1:9100 SILVERDALE WAY
Practice Address - Street 2:CLARK CHIROPRACTIC NECK & BACK
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8389
Practice Address - Country:US
Practice Address - Phone:360-692-1178
Practice Address - Fax:360-692-1210
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1687OtherLIC#
WA600 459882OtherUBI
WA184303OtherL&I PR#
WA54222Other1ST CHOICE
WA242426900OtherOWCP
WA5370CLOtherREG BS
WA1687OtherLIC#
WA184303OtherL&I PR#