Individual
DR. STEPHANIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
38-010216
IL
111NN1001X
Nutrition Chiropractor
Primary
8450809
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019272201
MEDICARE PTAN
NH
01
—
08132071
BCBS
NH
01
—
210028
MEDICARE PTAN
IL
Enumeration date
06/10/2005
Last updated
01/10/2020
Update your record
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