Individual
DR. RONALD FREDERICK CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5 NEWINGTON ROAD, WEST HARTFORD, CT 06110-2310
(860) 236-3364
(860) 236-3364
Mailing address
5 NEWINGTON ROAD, WEST HARTFORD, CT 06110-2310
(860) 236-3364
(860) 236-3364
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
000210
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04046611
—
CT
01
—
050000210CT01
BCBS
CT
Enumeration date
09/20/2006
Last updated
07/08/2007
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