Active NPI
Jeffrey Paul Clark, D.C.
- Chiropractor
- Lake Stevens, WA
National Provider Identifier
1366417487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH00002638
- Practice address
- 9633 Market Place
Suite #103
Lake Stevens, WA 98258 - Phone
- (425) 335-0300
- Fax
- (425) 335-0302
- NPI assigned
- Feb 22, 2006
- Last updated
- Mar 6, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH00002638 | WA | Primary |
Addresses
Primary practice location
9633 Market Place
Suite #103
Lake Stevens, WA 98258
Mailing address
9633 Market Place
Suite #103
Lake Stevens, WA 98258
Phone (425) 335-0300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 350052980 | Other | WA | RAILROAD MEDICARE |
| 43630 | Other | WA | WORKERS COMP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH00002638 | WA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walsh Chiropractic PLLC | Current | Accepting new patients | |
| Momentum Clinic | Chiropractor | Past | Accepting new patients |
| Lake Stevens Chiropractic, PLLC | Chiropractor | Past | Accepting new patients |
Locations
9633 Market Pl
Unit 103
Lake Stevens, WA 98258
Phone (425) 335-0300
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Lake Stevens, WA
- NPI 1013160191
-
dba Market Place Chiropractic
- Rehabilitation Chiropractor
- Lake Stevens, WA
- NPI 1497479893
-
dba Lake Stevens Chiropractic
- Chiropractor
- Lake Stevens, WA
- NPI 1467592741
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488758400000",
"number": "1366417487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9633 MARKET PLACE",
"address_2": "SUITE #103",
"city": "LAKE STEVENS",
"state": "WA",
"postal_code": "98258",
"telephone_number": "425-335-0300",
"fax_number": "425-335-0302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9633 MARKET PLACE",
"address_2": "SUITE #103",
"city": "LAKE STEVENS",
"state": "WA",
"postal_code": "98258",
"telephone_number": "425-335-0300",
"fax_number": "425-335-0302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JEFFREY",
"middle_name": "PAUL",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2017-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "CH00002638",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "350052980",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKERS COMP",
"identifier": "43630",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Stevens, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.