Provider Demographics
NPI:1851302814
Name:CLARK, DAVID JAMES (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
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 1:6015 FAYETTEVILLE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6254
Mailing Address - Country:US
Mailing Address - Phone:919-401-0444
Mailing Address - Fax:919-401-0446
Practice Address - Street 1:6015 FAYETTEVILLE RD STE 111
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6254
Practice Address - Country:US
Practice Address - Phone:919-401-0444
Practice Address - Fax:919-401-0446
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU92151Medicare UPIN
TX8B1271Medicare ID - Type Unspecified
TX606415OtherBLUE CROSS BLUE SHIELD