Provider Demographics
NPI:1790859908
Name:CLARK, TAMMI ANNETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMMI
Middle Name:ANNETTE
Last Name:CLARK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5141 MOORPARK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2163
Mailing Address - Country:US
Mailing Address - Phone:408-773-1833
Mailing Address - Fax:408-517-8979
Practice Address - Street 1:5141 MOORPARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2163
Practice Address - Country:US
Practice Address - Phone:408-773-1833
Practice Address - Fax:408-517-8979
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA23896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0238960Medicare UPIN
CADC0238960Medicare ID - Type Unspecified