Provider Demographics
NPI:1740360049
Name:CLARK, WILLIAM F (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:CLARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:154 WEST ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-4400
Mailing Address - Country:US
Mailing Address - Phone:860-632-1668
Mailing Address - Fax:860-632-1672
Practice Address - Street 1:154 WEST ST
Practice Address - Street 2:SUITE E
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4400
Practice Address - Country:US
Practice Address - Phone:860-632-1668
Practice Address - Fax:860-632-1672
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001321111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
132100OtherCONNECTICARE
905871CONNOtherPHCS PRIVATE HEALTHCARE SYSTEMS
U75980OtherWEBSTER
P2773574OtherOXFORD
611244OtherACN AMERICAN CHIROPRACTIC NETWORK
7139035OtherAETNA
U75980OtherLIBERTY MUTUAL
050001321CT02OtherANTHEM BLUE CROSS BLUE SHIELD
44-04334OtherUNITED HEALTHCARE
1397991OtherAIG
U75980OtherHMC HEALTH MANAGEMENT CENTER
U75980OtherGAB ROBBINS
350001404Medicare ID - Type Unspecified
U75980OtherGAB ROBBINS