Individual
DR. ROSS MYRACLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1307 W REELFOOT AVE, UNION CITY, TN 38261-5505
(731) 885-0461
Mailing address
1307 W REELFOOT AVE, UNION CITY, TN 38261-5505
(731) 885-0461
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
D.C. 2356
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093022600
GROUP NPI NUMBER
TN
Enumeration date
07/28/2009
Last updated
08/05/2011
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