Provider Demographics
NPI:1023296977
Name:CLARK, BRIAN ALAN (DC, BS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALAN
Last Name:CLARK
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
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Mailing Address - Street 1:4544 S LAMAR BLVD
Mailing Address - Street 2:STE 750
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1594
Mailing Address - Country:US
Mailing Address - Phone:512-288-7000
Mailing Address - Fax:866-212-5513
Practice Address - Street 1:4544 S LAMAR BLVD
Practice Address - Street 2:STE 750
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1594
Practice Address - Country:US
Practice Address - Phone:512-288-7000
Practice Address - Fax:866-212-5513
Is Sole Proprietor?:No
Enumeration Date:2008-02-02
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX10645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor