Provider Demographics
NPI:1487018644
Name:CLARKE, DYLAN MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:MICHAEL
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 1:1935 E BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5816
Mailing Address - Country:US
Mailing Address - Phone:719-475-8676
Mailing Address - Fax:719-578-0071
Practice Address - Street 1:1935 E BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5816
Practice Address - Country:US
Practice Address - Phone:719-475-8877
Practice Address - Fax:719-578-0071
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor