Clark Chiro S.C.
Organization Active NPI Chiropractor · Darien, IL
NPI 1306364575 · NPPES record last updated Sep 7, 2017
Key facts
- NPI
- 1306364575
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- CLARK CHIRO S.C.
- Practice address
- 2815 83Rd St
Darien, IL 60561-1660 - Phone
- (630) 481-6690
- NPI assigned
- Sep 7, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Kevin John Clark, D.C.
- Title
- President
- Phone
- (630) 481-6690
Practitioners 1
-
Kevin John Clark, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171114001019 | IL | Part B Supplier - Clinic/Group Practice | 6507122215 |
Receives reassigned benefits from 1 practitioner Practice locations: Darien, IL |
National Provider Directory
Locations
2815 83rd St
Darien, IL 60561
Phone (331) 777-5301
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
2815 83Rd St
Darien, IL 60561-1660
Mailing address
841 W Monroe St Apt 2a
Chicago, IL 60607-2670
Phone (630) 202-4696
Other providers in Darien, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.