Ellensburg Sport and Spine, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ELLENSBURG SPORT AND SPINE, LLC

Doing business as

Clark Chiropractic and Wellness

Practice address

314 N Pine St
Ellensburg, WA 98926-3366

Phone

(360) 791-6226

NPI assigned

Sep 28, 2021

Last updated

May 6, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dillon T Clark, DCNPI 1982180964

Title

Owner/Authorized Official

Phone

(360) 791-6226

Specialties & licenses 1

Addresses

Other names 1

• Clark Chiropractic and Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dillon Thomas Clark, DC

  • Chiropractor
  • Ellensburg, WA
  • NPI 1982180964
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651795200000",
    "number": "1376215483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 N PINE ST",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989263366",
            "telephone_number": "360-791-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 N PINE ST",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989263366",
            "telephone_number": "360-791-6226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLENSBURG SPORT AND SPINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-28",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DILLON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "360-791-6226",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark Chiropractic and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ellensburg Family Medicine (CompassDirect Healthcare)
• Ellensburg Integrative Medicine PLLC
• Ellensburg Pediatrics PLLC
• Ellensburg Physical Therapy Center Inc
• Ellensburg School District
• Ellensburg Ventures, L.L.C.
• Ellensburg Vision Clinic, PS, Inc (Family Eye Clinic)
• Elmview
• Elperin DDS, PLLC (Sunrise Dental of Ellensburg)
• Elperin DDS, PLLC (Sunrise Dental of Ellensburg)

• Chiropractor in Ellensburg, WA
• Providers in Ellensburg, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.