Provider Demographics
NPI:1396018040
Name:CLARKE CHIROPRACTIC AND REHABILITATION
Entity Type:Organization
Organization Name:CLARKE CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEREFFA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-769-0790
Mailing Address - Street 1:4000 N STATE ROAD 7
Mailing Address - Street 2:SUITE 409
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4804
Mailing Address - Country:US
Mailing Address - Phone:954-769-0790
Mailing Address - Fax:954-530-7267
Practice Address - Street 1:4000 N STATE ROAD 7
Practice Address - Street 2:SUITE 409
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-4804
Practice Address - Country:US
Practice Address - Phone:954-769-0790
Practice Address - Fax:954-530-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty