Active NPI
Michael L Clark, DC
- Chiropractor
- Missoula, MT
National Provider Identifier
1265530232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 656
- Practice address
- 3031 S Russell
Suite 4
Missoula, MT 59801 - Phone
- (406) 721-8825
- Fax
- (406) 327-6702
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 656 | MT | Primary |
Addresses
Primary practice location
3031 S Russell
Suite 4
Missoula, MT 59801
Mailing address
3031 S Russell
Suite 4
Missoula, MT 59801
Phone (406) 721-8825
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160706 | Medicaid | MT | |
| 40161 | Other | MT | BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080612000361 | MT | Practitioner - Chiropractic | 4688743081 | Practice locations: Missoula, MT |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Western States College of Chiropractic, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3031 S Russel
Suite 4
Missoula, MT 59801-8523
Phone (406) 721-8825
3031 S Russell St
Suite 4
Missoula, MT 59801-8523
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 656 | MT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202256000000",
"number": "1265530232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3031 S RUSSELL",
"address_2": "SUITE 4",
"city": "MISSOULA",
"state": "MT",
"postal_code": "59801",
"telephone_number": "406-721-8825",
"fax_number": "406-327-6702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3031 S RUSSELL",
"address_2": "SUITE 4",
"city": "MISSOULA",
"state": "MT",
"postal_code": "59801",
"telephone_number": "406-721-8825",
"fax_number": "406-327-6702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MICHAEL",
"middle_name": "L",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2008-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MT",
"license": "656",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "160706",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "40161",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; 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.