Provider Demographics
NPI:1932521283
Name:VOLK, CLARISSA
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:VOLK
Suffix:
Gender:F
Credentials:
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 125
Mailing Address - Street 2:
Mailing Address - City:WISHEK
Mailing Address - State:ND
Mailing Address - Zip Code:58495-0125
Mailing Address - Country:US
Mailing Address - Phone:701-452-2593
Mailing Address - Fax:
Practice Address - Street 1:20 N 5TH ST
Practice Address - Street 2:
Practice Address - City:WISHEK
Practice Address - State:ND
Practice Address - Zip Code:58495-7000
Practice Address - Country:US
Practice Address - Phone:701-452-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND962111N00000X
SD1249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor