Provider Demographics
NPI:1619938487
Name:UNGERANK, CLARENCE ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:ANTHONY
Last Name:UNGERANK
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 1:601 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-3400
Mailing Address - Country:US
Mailing Address - Phone:870-892-2544
Mailing Address - Fax:870-892-8200
Practice Address - Street 1:601 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-3400
Practice Address - Country:US
Practice Address - Phone:870-892-2544
Practice Address - Fax:870-892-8200
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59041OtherBCBS
ARU32946Medicare UPIN
AR59041OtherBCBS