Nathanial Bradley Clark, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038011046 Issued in IL

Practice address

1475 N Dilleys Rd
Unit 2
Gurnee, IL 60031-1708

Phone

(847) 244-8600

Fax

(847) 244-8602

NPI assigned

Nov 5, 2007

Last updated

Mar 28, 2011By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Nathanial Clark, D.C., S.C.

  • Chiropractor
  • Gurnee, IL
  • NPI 1477736221
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301270400000",
    "number": "1437339678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 N DILLEYS RD",
            "address_2": "UNIT 2",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600311708",
            "telephone_number": "847-244-8600",
            "fax_number": "847-244-8602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 N DILLEYS RD",
            "address_2": "UNIT 2",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600311708",
            "telephone_number": "847-244-8600",
            "fax_number": "847-244-8602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NATHANIAL",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-05",
        "last_updated": "2011-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justyna Chojnowski, DDS
• Raymond Bong Chow, M.D.
• Regan Alene Christopoulos, MD
• Duc Hien Chung, DDS
• Rupal Doshi Clair, O.D.
• Clinical Investigation Specialists, Inc.
• Clinicians Surgery Care Center. LLC.
• Clinicians Surgical Care of America LLC (Clinicians Surgery Care)
• Kenneth Close
• Co-Operative Partners in Therapy

• Chiropractor in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.