Provider Demographics
NPI:1063501641
Name:CLARK, MICHELLE CHRISTINE (D C)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:CLARK
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4013
Mailing Address - Country:US
Mailing Address - Phone:303-863-8330
Mailing Address - Fax:303-863-8187
Practice Address - Street 1:141 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4013
Practice Address - Country:US
Practice Address - Phone:303-863-8330
Practice Address - Fax:303-863-8187
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor