Provider Demographics
NPI:1861669962
Name:CLARK C. BYROAD D.C., P.A.
Entity Type:Organization
Organization Name:CLARK C. BYROAD D.C., P.A.
Other - Org Name:BYROAD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:BYROAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-219-0434
Mailing Address - Street 1:575 N VALLEY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3437
Mailing Address - Country:US
Mailing Address - Phone:972-219-0434
Mailing Address - Fax:
Practice Address - Street 1:575 N VALLEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3437
Practice Address - Country:US
Practice Address - Phone:972-219-0434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12504Medicare UPIN