Provider Demographics
NPI:1477784965
Name:BARTOK, CLINTON WILLIAM (LAC, DIPLOM)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:WILLIAM
Last Name:BARTOK
Suffix:
Gender:M
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 SIX FORKS RD
Mailing Address - Street 2:#202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4822 SIX FORKS RD
Practice Address - Street 2:#202
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5269
Practice Address - Country:US
Practice Address - Phone:919-788-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist