Provider Demographics
NPI:1831415355
Name:CLARKE, ROBERT JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:CLARKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:JOHN
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1519 9TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4600
Mailing Address - Country:US
Mailing Address - Phone:360-658-1987
Mailing Address - Fax:360-658-5618
Practice Address - Street 1:1519 9TH ST
Practice Address - Street 2:STE 101
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270
Practice Address - Country:US
Practice Address - Phone:360-658-5618
Practice Address - Fax:360-658-5618
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60145579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8892322Medicare PIN