Individual
DR. ETHAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
16600 S 4150 RD, CLAREMORE, OK 74017-0388
(918) 645-4112
Mailing address
6128 E 61ST ST, TULSA, OK 74136-2117
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4669
OK
Other
Enumeration date
06/06/2025
Last updated
06/06/2025
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