Provider Demographics
NPI:1619691722
Name:CLARK, DANIEL E (ND)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:CLARK
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W GUADALUPE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3333
Mailing Address - Country:US
Mailing Address - Phone:480-508-4226
Mailing Address - Fax:
Practice Address - Street 1:201 W GUADALUPE RD STE 301
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3333
Practice Address - Country:US
Practice Address - Phone:480-508-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22-1741175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath