Organization
CLARK CHIROPRACTIC CENTER, LLC
Active
Other names
Christopher R. Clark, D.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER RUSSELL CLARK I D.C. (SOLE MANAGER)
(724) 852-1777
Entity
Organization
Contact information
Practice address
177 E HIGH ST, WAYNESBURG, PA 15370-1818
(724) 852-1777
(724) 852-1777
Mailing address
177 E HIGH ST, WAYNESBURG, PA 15370-1818
(724) 852-1777
(724) 852-1777
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC007628L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL SECURITY NUMBER
PA
01
—
041052XGY
MEDICARE MEMBER PROVIDER
PA
05
—
1010082300001
—
PA
01
—
1134175474
INDIVIDUAL NPI NUMBER
PA
01
—
1326254798
NPI NUMBER - GROUP
PA
01
—
1666127
OGANIZATION BCBS NUMBER
PA
01
—
897504
INDIVIDUAL BCBS NUMBER
PA
Enumeration date
05/15/2007
Last updated
05/21/2020
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