Active NPI
Michael James Clark, D.C.
- Chiropractor
- Vero Beach, FL
National Provider Identifier
1508939877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH-00003973
- Practice address
- 2706 20TH St
Vero Beach, FL 32960-3001 - Phone
- (772) 567-0771
- Fax
- (772) 567-0575
- NPI assigned
- Nov 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | CH-00003973 | FL | Primary |
Addresses
Primary practice location
2706 20TH St
Vero Beach, FL 32960-3001
Mailing address
822 Barker St
Sebastian, FL 32958-4808
Phone (772) 567-0771
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 |
|---|---|---|---|
| CH-00003973 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489190400000",
"number": "1508939877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "822 BARKER ST",
"city": "SEBASTIAN",
"state": "FL",
"postal_code": "329584808",
"telephone_number": "772-567-0771",
"fax_number": "772-567-0575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2706 20TH ST",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329603001",
"telephone_number": "772-567-0771",
"fax_number": "772-567-0575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MICHAEL",
"middle_name": "JAMES",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-16",
"last_updated": "2017-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH-00003973",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vero Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.