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Individual

DR. RANDAL MARK CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
22711 43RD AVE S, KENT, WA 98032-8467
(253) 373-9902
(253) 661-6405
Mailing address
22711 43RD AVE S, KENT, WA 98032-8467
(253) 373-9902
(253) 661-6405

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1870
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
101394
L & I
WA
Enumeration date
03/07/2007
Last updated
07/08/2007
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