Provider Demographics
NPI:1538104781
Name:CLARK, JAMES ERNEST (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ERNEST
Last Name:CLARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MISS
Other - First Name:JAMES
Other - Middle Name:ERNEST
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:49346 ROAD 426
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-9016
Mailing Address - Country:US
Mailing Address - Phone:559-683-4448
Mailing Address - Fax:
Practice Address - Street 1:49346 ROAD 426
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9016
Practice Address - Country:US
Practice Address - Phone:559-683-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0283540Medicare UPIN