Provider Demographics
NPI:1861678096
Name:CLARKE, THOMAS J (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:CLARKE
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:PO BOX 2542
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-2542
Mailing Address - Country:US
Mailing Address - Phone:530-587-5358
Mailing Address - Fax:530-587-5979
Practice Address - Street 1:10021 MARTIS VALLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-2125
Practice Address - Country:US
Practice Address - Phone:530-587-5358
Practice Address - Fax:530-587-5979
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0176540OtherMEDICARE LEGACY NUMBER