Provider Demographics
NPI:1477736221
Name:NATHANIAL CLARK, D.C., S.C.
Entity Type:Organization
Organization Name:NATHANIAL CLARK, D.C., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-244-8600
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty