Individual
JOSEPH C. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
803 N FOREMAN ST, VINITA, OK 74301-1435
(918) 256-5111
(918) 256-5222
Mailing address
PO BOX 248, VINITA, OK 74301-0248
(918) 256-5111
(918) 256-5222
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4016
OK
111N00000X
Chiropractor
CHIR007743
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OKAAA2679
MEDICARE PTAN
OK
Enumeration date
07/25/2006
Last updated
08/27/2013
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