Provider Demographics
NPI:1942597430
Name:CLARKE, DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 E ALTAMONTE DR
Mailing Address - Street 2:STE 2250
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4652
Mailing Address - Country:US
Mailing Address - Phone:407-261-1001
Mailing Address - Fax:407-261-1003
Practice Address - Street 1:8865 COMMODITY CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9077
Practice Address - Country:US
Practice Address - Phone:407-354-0009
Practice Address - Fax:407-354-4882
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF0899ZMedicare UPIN