Individual
JERRY S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
3325 N UNIVERSITY AVE STE 125, PROVO, UT 84604-6615
(801) 374-2774
(801) 374-2775
Mailing address
3325 N UNIVERSITY AVE STE 125, PROVO, UT 84604-6615
(801) 374-2774
(801) 374-2775
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
166844-1202
UT
Other
Enumeration date
12/23/2006
Last updated
11/01/2016
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