Provider Demographics
NPI:1750314647
Name:CLARK, DANA ELMORE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:ELMORE
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 1:10780 SANTA MONICA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7614
Mailing Address - Country:US
Mailing Address - Phone:310-473-7130
Mailing Address - Fax:310-473-5077
Practice Address - Street 1:10780 SANTA MONICA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7614
Practice Address - Country:US
Practice Address - Phone:310-473-7130
Practice Address - Fax:310-473-5077
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWDC28616A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU93711Medicare UPIN
CAWDC28216AMedicare PIN