Provider Demographics
NPI:1508044181
Name:CLARK, THOMAS B (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
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 1:1035 E VISTA WAY # 128
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4606
Mailing Address - Country:US
Mailing Address - Phone:760-940-8900
Mailing Address - Fax:760-630-5629
Practice Address - Street 1:2092 CASA DE VEREDA
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4223
Practice Address - Country:US
Practice Address - Phone:760-940-8900
Practice Address - Fax:760-630-5629
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor