Clark Chiropractic Center, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

CLARK CHIROPRACTIC CENTER, LLC

Practice address

4900 N Glen Park Place Rd Ste B
Peoria, IL 61614-4685

Phone

(309) 645-9665

NPI assigned

Dec 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer M. Clark, D.C.NPI 1144389024

Title

Owner

Phone

(309) 645-9665

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer M. Clark, D.C.

  • Chiropractor
  • Peoria, IL
  • NPI 1144389024
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215090337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 W CENTENNIAL DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 N GLEN PARK PLACE RD STE B",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144685",
            "telephone_number": "309-645-9665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK CHIROPRACTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-645-9665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brynn N Cinnamon, APN/CNP
• Gabriela Ciofoaia, M.D.
• Ciwirc ( Central Illinois Work Injury Resource Center )
• CK-Caregivers, LLC
• Bailey Clarahan
• Alyse B Clark, PT
• Jacob Clark
• Jennifer M. Clark, D.C.
• Michala Eileen Clark, DO
• Sue Clark, MD

• Chiropractor in Peoria, IL
• Providers in Peoria, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.