Provider Demographics
NPI:1437339678
Name:CLARK, NATHANIAL BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHANIAL
Middle Name:BRADLEY
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 1:1475 N DILLEYS RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1708
Mailing Address - Country:US
Mailing Address - Phone:847-244-8600
Mailing Address - Fax:847-244-8602
Practice Address - Street 1:1475 N DILLEYS RD
Practice Address - Street 2:UNIT 2
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1708
Practice Address - Country:US
Practice Address - Phone:847-244-8600
Practice Address - Fax:847-244-8602
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor