Provider Demographics
NPI:1932713401
Name:CLARK CLINICAL CONSULTING LLC
Entity Type:Organization
Organization Name:CLARK CLINICAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:V
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:704-266-3250
Mailing Address - Street 1:10926 DAVID TAYLOR DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0039
Mailing Address - Country:US
Mailing Address - Phone:704-266-3250
Mailing Address - Fax:704-266-3250
Practice Address - Street 1:10926 DAVID TAYLOR DR STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-0039
Practice Address - Country:US
Practice Address - Phone:704-266-3250
Practice Address - Fax:704-266-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty