Clinton Russell Stark, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC24623 Issued in CA

Practice address

13771 Newport Ave
Suite 8
Tustin, CA 92780-4693

Phone

(714) 368-7600

Fax

(714) 368-7630

NPI assigned

Dec 29, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Stark Chiropractic, Inc.

  • Chiropractor
  • Tustin, CA
  • NPI 1306040001
  NPD (past) Authorized official
• Francisco Tagle Chiropractic, Inc

  • Chiropractor
  • Tustin, CA
  • NPI 1205247715
  NPD (past)

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124184593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13771 NEWPORT AVE",
            "address_2": "SUITE 8",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927804693",
            "telephone_number": "714-368-7600",
            "fax_number": "714-368-7630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13771 NEWPORT AVE",
            "address_2": "SUITE 8",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927804693",
            "telephone_number": "714-368-7600",
            "fax_number": "714-368-7630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "CLINTON",
        "middle_name": "RUSSELL",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC24623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "54220DC0246230",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Anthony St. John, RRW
• Nikki Dionne Pil Sta Teresa
• Susan M. Stalzer, M.D.
• William B Stanford, O.D.
• Stark Chiropractic, Inc.
• Madison D Stark
• State-of-the-Art Physical Therapy, Inc.
• Kylie Stelung
• Amy Stengel, PA-C
• Stephanie Flores Licensed Clinical Social Worker Inc.

• Chiropractor in Tustin, CA
• Providers in Tustin, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.