Provider Demographics
NPI:1558517201
Name:CLARKE, DAMIAN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:ALLEN
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 1:6445 S 12TH AVE
Mailing Address - Street 2:STE 151
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-7680
Mailing Address - Country:US
Mailing Address - Phone:520-294-6200
Mailing Address - Fax:520-294-6201
Practice Address - Street 1:6445 S 12TH AVE
Practice Address - Street 2:STE 151
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-7680
Practice Address - Country:US
Practice Address - Phone:520-294-6200
Practice Address - Fax:520-294-6201
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor