Individual
PAUL K CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
725 E COMMERCIAL AVE, LOWELL, IN 46356-2303
(219) 696-1910
(815) 839-9001
Mailing address
725 E COMMERCIAL AVE, LOWELL, IN 46356-2303
(219) 696-1910
(815) 839-9001
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001448A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000314573
ANTHEM BCBS PROVIDER NO
IN
05
—
200010730
—
IN
Enumeration date
08/02/2006
Last updated
04/26/2011
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