Provider Demographics
NPI:1629144654
Name:CLARKSON, KARL D (DC)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:D
Last Name:CLARKSON
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 1:403 HOWARD STREET
Mailing Address - Street 2:
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1106
Mailing Address - Country:US
Mailing Address - Phone:304-592-3301
Mailing Address - Fax:304-592-2130
Practice Address - Street 1:403 HOWARD STREET
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-1106
Practice Address - Country:US
Practice Address - Phone:304-592-3301
Practice Address - Fax:304-592-2130
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV407111N00000X
WV407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1024124OtherWC
000080382OtherMSBC
WV0132440000Medicaid
5545040OtherAETNA
WVWV00407OtherHEALTH PLAN
T32382Medicare UPIN