Active NPI
Robert Dean Clark, D.O.
- Chiropractor
- Winslow, ME
National Provider Identifier
1629174461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CR1063
- Practice address
- 28 Clinton Ave Ste 2
Winslow, ME 04901-7076 - Phone
- (207) 873-0904
- Fax
- (207) 873-0904
- NPI assigned
- Sep 16, 2006
- 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 | CR1063 | ME | Primary |
Addresses
Primary practice location
28 Clinton Ave Ste 2
Winslow, ME 04901-7076
Mailing address
28 Clinton Ave Ste 2
Winslow, ME 04901-7076
Phone (207) 873-0904
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C0425 | Other | ME | ANTHEM BLUE CROSS BLUE SH |
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CR1063 | ME | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629174461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 CLINTON AVE STE 2",
"city": "WINSLOW",
"state": "ME",
"postal_code": "049017076",
"telephone_number": "207-873-0904",
"fax_number": "207-873-0904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 CLINTON AVE STE 2",
"city": "WINSLOW",
"state": "ME",
"postal_code": "049017076",
"telephone_number": "207-873-0904",
"fax_number": "207-873-0904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ROBERT",
"middle_name": "DEAN",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ME",
"license": "CR1063",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS BLUE SH",
"identifier": "C0425",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winslow, ME
Sources for this page
- 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.