Dale Eugene Clark, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00001250 Issued in WA

Practice address

109 Rainier Ave So Ste C
Eatonville, WA 98328-0546

Phone

(360) 832-6200

NPI assigned

Feb 15, 2007

Sex

Male

Sole proprietor

No

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)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386787398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 546",
            "address_2": "109 RAINIER AVE SO, STE C",
            "city": "EATONVILLE",
            "state": "WA",
            "postal_code": "983280546",
            "telephone_number": "360-832-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 RAINIER AVE SO STE C",
            "city": "EATONVILLE",
            "state": "WA",
            "postal_code": "983280546",
            "telephone_number": "360-832-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DALE",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00001250",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "2103109",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aurora Cedar Collective LLC
• Taylor Bradley
• Melissa Bronoske, PA-C
• Athena Ann Brown, LMP
• Lynn Marie Butler, CRNA
• Rachel Elizabeth Como
• Cross Chiropractic PS
• Diane Marie Crum, DNP
• Eatonville Integrative Medicine P.S. (Eatonville Integrative Medicine)
• Eatonville School District

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.