Lake Placid Chiropractic Clinic, Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH7378 Issued in FL

Legal business name

LAKE PLACID CHIROPRACTIC CLINIC, INC

Practice address

2411 US Highway 27 S
Sebring, FL 33870-4943

Phone

(863) 382-9632

Fax

(863) 382-9632

NPI assigned

May 28, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Robert T Clark Sr., D.C.

Title

Owner

Phone

(863) 699-6824

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1243468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253232000000",
    "number": "1225263601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 US HIGHWAY 27 S",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338704943",
            "telephone_number": "863-382-9632",
            "fax_number": "863-382-9632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 US HIGHWAY 27 S",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338704943",
            "telephone_number": "863-382-9632",
            "fax_number": "863-382-9632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PLACID CHIROPRACTIC CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-28",
        "last_updated": "2009-09-18",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-699-6824",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH7378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3814891-00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "55739",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Sebring, FL
• Providers in Sebring, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2009; 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.