Diane Marie Clark, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH5971 Issued in FL

Practice address

4705 S Clyde Morris Blvd
Port Orange, FL 32129-4103

Phone

(386) 763-2728

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. Diane Marie Clark Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Palmer College FoundationGroup PAC ID 1557266863, 44 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Palmer College Foundation

  dba Palmer College of Chiropractic Florida

  • Chiropractor
  • Port Orange, FL
  • NPI 1568552255
  Medicare reassignment Care Compare group NPD
• Palmer College Foundation

  dba Palmer Chiropractic Clinic

  • Chiropractor
  • Davenport, IA
  • NPI 1174535181
  NPD

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355875200000",
    "number": "1306994637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 S CLYDE MORRIS BLVD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321294103",
            "telephone_number": "386-763-2728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 S CLYDE MORRIS BLVD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321294103",
            "telephone_number": "386-763-2728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DIANE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2012-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH5971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "22574",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00706874",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001509400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "CLARK",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "D.C.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Noah Chudy
• Arturo Madrona Cimafranca Jr.
• Michael Antony Ciolfi, DC, HBPE,BSE
• City of Port Orange
• Tamara R Clancy, MD
• Lauren Clark
• Leslie A Clark, APRN
• Felicia Clarke
• Sarah Clarke
• Brittany Michele Claude

• Chiropractor in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; 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.

Verify at the official NPI Registry.