Provider Demographics
NPI:1730283169
Name:CLARK, SEAN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PAUL
Last Name:CLARK
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 1:22162 CAMINITO AMOR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1636
Mailing Address - Country:US
Mailing Address - Phone:949-215-6881
Mailing Address - Fax:
Practice Address - Street 1:3900 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2206
Practice Address - Country:US
Practice Address - Phone:949-756-2277
Practice Address - Fax:949-756-2146
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-29683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor