Individual
DR. KENT EDWARD CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
15B LOUDOUN ST SW, LEESBURG, VA 20175-2908
(703) 779-7909
Mailing address
15B LOUDOUN ST SW, LEESBURG, VA 20175-2908
(703) 779-7909
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104-557256
VA
111NN1001X
Nutrition Chiropractor
8302
AZ
Other
Enumeration date
10/10/2011
Last updated
09/14/2015
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