NPIMap

Organization Active NPI

Michael G Clark DC SC

  • Chiropractor
  • Wilmette, IL
National Provider Identifier
1316224678
Registry record updated Nov 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038006241 Issued in IL
Legal business name
MICHAEL G CLARK DC SC
Practice address
1159 Wilmette Ave
Suite 228
Wilmette, IL 60091-2649
Phone
(847) 251-6707
Fax
(847) 251-9660
NPI assigned
Nov 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2011

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

Authorized official

Name
Michael G Clark, DC
Title
President
Phone
(847) 251-6707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038006241 IL Primary

Addresses

Primary practice location

1159 Wilmette Ave
Suite 228
Wilmette, IL 60091-2649

Mailing address

1159 Wilmette Ave
Suite 228
Wilmette, IL 60091-2649
Phone (847) 251-6707

National Provider Directory

National Provider Directory

Locations

1159 Wilmette Ave
Ste 228
Wilmette, IL 60091
Phone (847) 251-6707

NPI Registry JSON

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321228800000",
    "number": "1316224678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1159 WILMETTE AVE",
            "address_2": "SUITE 228",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912649",
            "telephone_number": "847-251-6707",
            "fax_number": "847-251-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1159 WILMETTE AVE",
            "address_2": "SUITE 228",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912649",
            "telephone_number": "847-251-6707",
            "fax_number": "847-251-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL G CLARK DC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2011-11-14",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-251-6707",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038006241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmette, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; 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.