Individual
DR. KARSON ELLSWORTH CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
11 HILL ST, LYNDONVILLE, VT 05851-8911
(802) 626-5866
(802) 626-0980
Mailing address
11 HILL ST, LYNDONVILLE, VT 05851-8911
(802) 626-5866
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
006-0001143
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75-3165676
TAX IDENTIFICATION NUMBER
VT
Enumeration date
03/22/2007
Last updated
01/26/2012
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