Provider Demographics
NPI:1922558550
Name:LARK CHIROPRACTIC
Entity Type:Organization
Organization Name:LARK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-221-6234
Mailing Address - Street 1:125 E BARSTOW AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5023
Mailing Address - Country:US
Mailing Address - Phone:559-221-6234
Mailing Address - Fax:559-221-4698
Practice Address - Street 1:125 E BARSTOW AVE STE 150
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5023
Practice Address - Country:US
Practice Address - Phone:559-221-6234
Practice Address - Fax:559-221-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC198860Medicare UPIN