Clark Chiropractic Center, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC007628L Issued in PA

Legal business name

CLARK CHIROPRACTIC CENTER, LLC

Practice address

177 E High St
Waynesburg, PA 15370-1818

Phone

(724) 852-1777

Fax

(724) 852-1777

NPI assigned

May 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Christopher Russell Clark I, D.C.

Title

Sole Manager

Phone

(724) 852-1777

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Christopher R. Clark, D.C. Other name

Locations

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1326254798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 E HIGH ST",
            "city": "WAYNESBURG",
            "state": "PA",
            "postal_code": "153701818",
            "telephone_number": "724-852-1777",
            "fax_number": "724-852-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 E HIGH ST",
            "city": "WAYNESBURG",
            "state": "PA",
            "postal_code": "153701818",
            "telephone_number": "724-852-1777",
            "fax_number": "724-852-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK CHIROPRACTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "SOLE MANAGER",
        "authorized_official_telephone_number": "724-852-1777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC007628L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OGANIZATION BCBS NUMBER",
            "identifier": "1666127",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL SECURITY NUMBER",
            "identifier": "$$$$$$$$$",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010082300001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1134175474",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER - GROUP",
            "identifier": "1326254798",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE MEMBER PROVIDER",
            "identifier": "041052XGY",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL BCBS NUMBER",
            "identifier": "897504",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christopher R. Clark, D.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Prayun Chayapruks, MD CMD
• Betsy Christman
• Daniel Alan Church, M.D.
• Robert Edward Cicchino Jr., DO
• Nicholas Anthony Cicci, PHARMD
• Christopher Russell Clark, D.C.
• Darcie Lynn Coen, LPC
• Brian Coleman, DPT
• Mary Comer, PHYSICIAN ASSISTANT
• Meghan Brooke Conrad

• Chiropractor in Waynesburg, PA
• Providers in Waynesburg, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; 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.