Jerry S Clark, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

166844-1202 Issued in UT

Practice address

3325 N University Ave Ste 125
Provo, UT 84604-6615

Phone

(801) 374-2774

Fax

(801) 374-2775

NPI assigned

Dec 23, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Chiropractic

Education

Western States College of Chiropractic, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• UT PPO
• UT PPO D-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alpine Spinal Rehabilitation Ctr

  • Chiropractor
  • Provo, UT
  • NPI 1578731949
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477958400000",
    "number": "1114082872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 N UNIVERSITY AVE STE 125",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046615",
            "telephone_number": "801-374-2774",
            "fax_number": "801-374-2775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 N UNIVERSITY AVE STE 125",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046615",
            "telephone_number": "801-374-2774",
            "fax_number": "801-374-2775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JERRY",
        "middle_name": "S",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-23",
        "last_updated": "2016-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "166844-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Kailey Clark
• Chery C. Clark, OT
• Emily Sue Clark
• Jayce Dean Clark II
• Jennifer Jean Clark, PA
• Jonni Nichole Clark
• Kristyn Clark
• Natalie Clark, RN
• Nicole Anne Clark, MD
• Sydney Clark

• Chiropractor in Provo, UT
• Providers in Provo, UT by specialty
• Chiropractor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.