Provider Demographics
NPI:1972610475
Name:CLARKE, STEPHEN L (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
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 338
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877
Mailing Address - Country:US
Mailing Address - Phone:423-581-7629
Mailing Address - Fax:423-581-6551
Practice Address - Street 1:6156 WEST ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877
Practice Address - Country:US
Practice Address - Phone:423-581-7629
Practice Address - Fax:423-581-6551
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3676064Medicaid
TX3676064Medicaid
U26483Medicare UPIN