Individual
MRS. SANDRA A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
6646 W JOHNSON RD, LA PORTE, IN 46350-8243
(866) 932-9630
Mailing address
6646 W JOHNSON RD, LA PORTE, IN 46350-8243
(866) 932-9630
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002710A
IN
111NP0017X
Pediatric Chiropractor
08002710A
IN
Other
Enumeration date
07/05/2006
Last updated
01/13/2014
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