Paul K Clark, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

08001448A Issued in IN

Practice address

725 E Commercial Ave
Lowell, IN 46356-2303

Phone

(219) 696-1910

Fax

(815) 839-9001

NPI assigned

Aug 2, 2006

Last updated

Apr 26, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Elkhart County Chiropractic

  • Chiropractor
  • Goshen, IN
  • NPI 1508895426
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303776000000",
    "number": "1154338945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 E COMMERCIAL AVE",
            "city": "LOWELL",
            "state": "IN",
            "postal_code": "463562303",
            "telephone_number": "219-696-1910",
            "fax_number": "815-839-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 E COMMERCIAL AVE",
            "city": "LOWELL",
            "state": "IN",
            "postal_code": "463562303",
            "telephone_number": "219-696-1910",
            "fax_number": "815-839-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PAUL",
        "middle_name": "K",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2011-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08001448A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200010730",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PROVIDER NO",
            "identifier": "000000314573",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Joseph Butera, LMHC, LCAC, NCC, CHP
• Kelly Ann Calvillo, MHS
• Kelley Campbell, PHARMD
• Kathryn Camus
• Anastasia Christakis-Szostek
• David W Conaway, D.D.S.
• Rhonda Sue Courtright, MSW
• Susan Marie Cummings, COTA
• Joshua Nathaniel Degood, D.C.
• Donald W Pulver,DDS,PC

• Chiropractor in Lowell, IN
• Providers in Lowell, IN by specialty
• Chiropractor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; 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.