DR. JACK J CLARK (NPI# 1902881014) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902881014 |
| Entity Type | Individual |
| Full Name | DR. JACK J CLARK |
| Credential | D.C. |
| Practice Address |
6015 E State Blvd Fort Wayne IN 46815-7638 |
| Practice Telephone | 2604861886 |
| Mailing Telephone | 2604861886 |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2010-06-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 08000717A | IN | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100289660A | 05 | |
| IN | BLUE CROSS/BLUE SHIELD | 000000086699 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083840342 | Jack R Clark | Dentist | 1856 Lancaster Rd, Homewood, AL 35209-4114 | 2009-06-01 |
| 1265571608 | Jack Douglas Clark | Ophthalmology | 7112 N Fresno St, Suite 100, Fresno, CA 93720-2940 | 2007-02-05 |
| 1346320140 | Jack Prow Clark | Family Medicine | 518 Ems D15 Ln, Syracuse, IN 46567-8026 | 2006-10-16 |
| 1306824016 | Jack Crowley Clark Sr. | Radiology | 1431 Centerpoint Blvd, Teamhealth Radiology Ste 100, Knoxville, TN 37932-1984 | 2006-01-03 |
| 1477799112 | Jack Clark | Counselor | 4411 N Cedar Ave, Fresno, CA 93726-2538 | 2008-12-31 |
| 1841311487 | Jack Malcolm Clark IIi | Social Worker | 7711 Madonna, San Antonio, TX 78216-6620 | 2007-04-02 |
| 1902992837 | Jack O. Clark | Internal Medicine | 450 E Main St, Rexburg, ID 83440 | 2006-10-05 |
| 1427092857 | Jack C Clark | Family Medicine | 103 Midlake Dr, Knoxville, TN 37918-3039 | 2006-06-15 |
| 1588616882 | Jack Lewis Clark | Oral & Maxillofacial Surgery | 21700 Northwestern Hwy, Suite 1290, Southfield, MI 48075-4906 | 2006-05-16 |
| 1073563847 | Jack Clark | Internal Medicine | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2006-05-11 |
| Street Address |
6015 E STATE BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46815-7638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083820302 | Jack J. Clark, D.c.p.c. | Chiropractor | 6015 E State Blvd, Fort Wayne, IN 46815-7638 | 2007-05-15 |
| 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 DR. JACK J CLARK.
| 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.