Provider Demographics
NPI:1073049326
Name:INSPIRED FAMILY CHIROPRACTIC A CLARK CORPORATION
Entity Type:Organization
Organization Name:INSPIRED FAMILY CHIROPRACTIC A CLARK CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:CASSE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-347-6617
Mailing Address - Street 1:18635 SOLEDAD CANYON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3725
Mailing Address - Country:US
Mailing Address - Phone:661-347-6617
Mailing Address - Fax:
Practice Address - Street 1:18635 SOLEDAD CANYON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-3725
Practice Address - Country:US
Practice Address - Phone:661-347-6617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty