Individual
DR. JOHNATHAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
542 S STATE ST, SPARTA, MI 49345-1547
(616) 887-2178
Mailing address
542 S STATE ST, SPARTA, MI 49345-1547
(616) 887-2178
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
0104557282
VA
111N00000X
Chiropractor
Primary
2301010324
MI
111N00000X
Chiropractor
DC011132
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
504995ZU84
MEDICARE
PA
Enumeration date
11/02/2015
Last updated
11/13/2019
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