Organization
ICARUS CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNATHAN CLARK DC (OWNER)
(724) 422-8070
Entity
Organization
Contact information
Practice address
210 6TH ST, SUITE 7, CLYMER, PA 15728-1257
(724) 422-8070
(724) 905-8084
Mailing address
210 6TH ST, SUITE 7, CLYMER, PA 15728-1257
(724) 422-8070
(724) 905-8084
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
DC011132
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
504984
MEDICARE
PA
Enumeration date
04/13/2016
Last updated
06/15/2016
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