NPIMap

Organization Active NPI

Clark Chiropractic and Massage PS

  • Clinic/Center
  • Port Angeles, WA
National Provider Identifier
1659783363
Registry record updated May 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
CHIR.CH.60465702 Issued in WA
Legal business name
CLARK CHIROPRACTIC AND MASSAGE PS
Practice address
601 S Race St Ste C
Port Angeles, WA 98362-6400
Phone
(360) 452-7636
NPI assigned
May 29, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2014

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

Authorized official

Name
Dustin Clark, D.C.NPI 1225449671
Title
President
Phone
(360) 452-7636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X CHIR.CH.60465702 WA Primary

Addresses

Primary practice location

601 S Race St Ste C
Port Angeles, WA 98362-6400

Mailing address

601 S Race St Ste C
Port Angeles, WA 98362-6400
Phone (360) 452-7636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140702000540 WA Part B Supplier - Clinic/Group Practice 3779708995 Receives reassigned benefits from 1 practitioner
Practice locations: Port Angeles, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401321600000",
    "number": "1659783363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S RACE ST STE C",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626400",
            "telephone_number": "360-452-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S RACE ST STE C",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626400",
            "telephone_number": "360-452-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK CHIROPRACTIC AND MASSAGE PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-29",
        "last_updated": "2014-05-29",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-452-7636",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "CHIR.CH.60465702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; 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.