Individual
DR. DEIRDRE V CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC, ND, CHT, CCRA
Contact information
Practice address
10926 DAVID TAYLOR DR STE 120, CHARLOTTE, NC 28262-1042
(704) 266-3250
Mailing address
10926 DAVID TAYLOR DR STE 120, CHARLOTTE, NC 28262-0039
(704) 266-3250
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5172
NC
111NI0013X
Independent Medical Examiner Chiropractor
5171
NC
111NI0013X
Independent Medical Examiner Chiropractor
5172
NC
171M00000X
Case Manager/Care Coordinator
—
—
1744R1102X
Research Study Specialist
—
—
175F00000X
Naturopath
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5172
CHIROPRACTIC LICENSE
NC
Enumeration date
01/06/2011
Last updated
08/27/2020
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