Individual
CHAD ALAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
560 MEMORIAL DR STE C, POCATELLO, ID 83201-4073
(208) 232-4267
(855) 319-1499
Mailing address
560 MEMORIAL DR STE C, POCATELLO, ID 83201-4073
(208) 232-4267
(855) 319-1499
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT - 3181
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
ID
Enumeration date
05/30/2013
Last updated
05/30/2013
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