John Clark, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

MC03097 Issued in NJ

Practice address

1300 Black Horse Pike
Glendora, NJ 08029-1308

Phone

(856) 939-8889

Fax

(856) 939-5057

NPI assigned

Jun 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1316985278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1448 ELLIS MILL RD",
            "city": "MONROEVILLE",
            "state": "NJ",
            "postal_code": "083432816",
            "telephone_number": "856-223-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BLACK HORSE PIKE",
            "city": "GLENDORA",
            "state": "NJ",
            "postal_code": "080291308",
            "telephone_number": "856-939-8889",
            "fax_number": "856-939-5057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "MC03097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8013705",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bancroft a New Jersey Nonprofit Corporation
• Claire P Berger, M.S., CCC-SLP
• Beth R. Bergman, MSN, RN, APN-C
• Benjamin Ira Blank, D.O.
• Shannon Carey
• Aja Brianna Corchado
• Jillian Defrank, PA-C
• Michael James Dulin, PTA
• Shane Famille, PT, ATC
• Forward Counseling LLC

• Chiropractor in Glendora, NJ
• Providers in Glendora, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; 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.