JACK J. CLARK, D.C.P.C. (NPI# 1083820302) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083820302 |
| Entity Type | Organization |
| Organization Name | JACK J. CLARK, D.C.P.C. |
| Practice Address |
6015 E State Blvd Fort Wayne IN 46815-7638 |
| Practice Telephone | 2604861886 |
| Mailing Telephone | 2604861886 |
| Mailing Fax Number | 2604853958 |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2008-06-27 |
| Authorized Official Name | MRS. VALERIE BADIAC (OFFICE MANAGER) |
| Authorized Official Telephone | 2604861886 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111NR0400X |
Chiropractor Specialization: Rehabilitation |
08002245A | IN | Chiropractic Providers |
| Y | 111N00000X | Chiropractor | 08000717A | IN | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100289660A | 05 |
| Street Address |
6015 E STATE BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46815-7638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902881014 | Jack J Clark | Chiropractor | 6015 E State Blvd, Fort Wayne, IN 46815-7638 | 2005-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306305438 | Sullivan Services, Inc. | In Home Supportive Care | 2789-b Maplecrest Rd, Fort Wayne, IN 46815 | 2019-03-18 |
| 1598250144 | Altermease Gleason | Massage Therapist | 3406 Thames Drive, Fort Wayne, IN 46815 | 2018-06-26 |
| 1881000222 | Denise Sparks | Specialist | 6415 Benham Drive, Fort Wayne, IN 46815 | 2014-07-07 |
| 1962823138 | Chad Distelrath | Physical Therapy Assistant | 1717 Maplecrest Rd, Apt 112, Fort Wayne, IN 46815 | 2013-12-13 |
| 1689943409 | Kendall Joan Labrash | Physical Therapist | 4251 Lahmeyer Rd., Fort Wayne, IN 46815 | 2011-12-22 |
| 1801179718 | Jayson Laube | Pharmacist | 6201 Stellhorn, Fort Wayne, IN 46815 | 2011-09-27 |
| 1720294432 | Muscle Therapy Clinic LLC | Massage Therapist | 6409 Georgetown North Blvd, Fort Wayne, IN 46815 | 2007-05-16 |
| 1427186436 | Legoras Conture Fashions | Prosthetic/Orthotic Supplier | 3316 Inwood Drive, Fort Wayne, IN 46815 | 2007-03-01 |
| 1932252772 | Fort Wayne Smiles PC | Dentist | 2031 Reed Road, Fort Wayne, IN 46815 | 2007-01-18 |
| 1811078538 | Timothy Doody Lynch | Dentist | 4207 Hobson Court, Fort Wayne, IN 46815 | 2006-10-18 |
| Find all providers in zip 46815 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952891236 | Lindsay Mack | Chiropractor | 6121 Stoney Creek Dr, Fort Wayne, IN 46825-4408 | 2018-05-13 |
| 1114438595 | Anne Therese Venderley | Chiropractor | 6388 W Jefferson Blvd Ste B, Fort Wayne, IN 46804-3075 | 2017-10-12 |
| 1720506413 | Crossroads Wellness Center, LLC | Chiropractor | 9206 Lima Rd, Fort Wayne, IN 46818-1806 | 2017-09-01 |
| 1134575095 | New Life Health & Wellness Sw, LLC | Chiropractor | 10210 Chestnut Plaza Dr, Fort Wayne, IN 46814-8970 | 2016-05-10 |
| 1518359371 | Jennifer Michele Williams | Chiropractor | 122 E Collins Rd, Fort Wayne, IN 46825-5302 | 2015-03-03 |
| 1609209691 | Caleb Parker Suciu | Chiropractor | 1114 W. Cook Road, Fort Wayne, IN 46825 | 2013-08-14 |
| 1417297839 | Spine Center of Fort Wayne | Chiropractor | 3417 E State Blvd, Fort Wayne, IN 46805-4830 | 2013-02-21 |
| 1821335936 | Northeast Chiropractic Center, Inc | Chiropractor | 6633 E State Blvd, Ste 200, Fort Wayne, IN 46815-7010 | 2013-01-09 |
| 1558612929 | Chiropractic Care & Wellness Center, LLC | Chiropractor | 6388 W Jefferson Blvd, Suite B, Fort Wayne, IN 46804-3075 | 2012-09-26 |
| 1831475755 | Thomas Chiropractic | Chiropractor | 3162 Mallard Cove Ln, Fort Wayne, IN 46804-2882 | 2011-10-24 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46815 |
Please comment or provide details below to improve the information on JACK J. CLARK, D.C.P.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.