Provider Demographics
NPI:1598836389
Name:GIAGIARI-CLARKE, MARY JO (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JO
Last Name:GIAGIARI-CLARKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-4812
Mailing Address - Country:US
Mailing Address - Phone:650-948-2238
Mailing Address - Fax:650-948-2363
Practice Address - Street 1:644 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-4812
Practice Address - Country:US
Practice Address - Phone:650-948-2238
Practice Address - Fax:650-948-2363
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC018416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0184161Medicare ID - Type Unspecified
DC0184161Medicare Oscar/Certification
U30982Medicare UPIN