Provider Demographics
NPI:1962863753
Name:CLARK, ADELE JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:ADELE
Middle Name:JANE
Last Name:CLARK
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 1:23100 PACIFIC HWY S STE 201
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-7281
Mailing Address - Country:US
Mailing Address - Phone:206-824-9500
Mailing Address - Fax:206-824-9654
Practice Address - Street 1:23100 PACIFIC HWY S STE 201
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-7281
Practice Address - Country:US
Practice Address - Phone:206-824-9500
Practice Address - Fax:206-824-9654
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60619222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor