Provider Demographics
NPI:1750334546
Name:CLARK, JAMES A (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:CLARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28800 W 8 MILE RD
Mailing Address - Street 2:STE 5858
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5906
Mailing Address - Country:US
Mailing Address - Phone:248-477-5858
Mailing Address - Fax:248-471-6270
Practice Address - Street 1:28800 W 8 MILE RD
Practice Address - Street 2:STE 5858
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5906
Practice Address - Country:US
Practice Address - Phone:248-477-5858
Practice Address - Fax:248-471-6270
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJC002441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H252480OtherBCBSM
MIMI5939Medicare UPIN