Provider Demographics
NPI:1922352483
Name:C & R HELATH
Entity Type:Organization
Organization Name:C & R HELATH
Other - Org Name:CLARK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:N
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-697-3737
Mailing Address - Street 1:20307 VIKING AVE NW STE 102
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8321
Mailing Address - Country:US
Mailing Address - Phone:360-697-3737
Mailing Address - Fax:360-779-6337
Practice Address - Street 1:20307 VIKING AVE NW STE 102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8321
Practice Address - Country:US
Practice Address - Phone:360-697-3737
Practice Address - Fax:360-779-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60282066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty