Provider Demographics
NPI:1477674836
Name:CLARKE, STEVEN G (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:CLARKE
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 1:25 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1131
Mailing Address - Country:US
Mailing Address - Phone:973-235-1515
Mailing Address - Fax:973-235-0452
Practice Address - Street 1:25 HIGH ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1131
Practice Address - Country:US
Practice Address - Phone:973-235-1515
Practice Address - Fax:973-235-0452
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ453664M94Medicare PIN