NPIMap

Organization Active NPI

Clark Chiropractic Inc

  • Chiropractor
  • Renton, WA
National Provider Identifier
1700904778
Registry record updated May 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2219 Issued in WA
Legal business name
CLARK CHIROPRACTIC INC
Practice address
17422 108TH Ave SE
101
Renton, WA 98055-5400
Phone
(425) 255-0427
Fax
(425) 255-1066
NPI assigned
Mar 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2011

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

Authorized official

Name
Mr. Theodore Jeffrey Clark, DC
Title
Owner Practitioner
Phone
(425) 255-0427

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2219 WA Primary

Addresses

Primary practice location

17422 108TH Ave SE
101
Renton, WA 98055-5400

Mailing address

17422 108TH Ave SE #101
Renton, WA 98055-5400
Phone (425) 255-0427

National Provider Directory

National Provider Directory

Locations

17422 108th Ave SE
Ste 101
Renton, WA 98055
Phone (425) 255-0427

Practitioners & affiliated clinicians

Practitioners 2

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305244800000",
    "number": "1700904778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17422 108TH AVE SE #101",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555400",
            "telephone_number": "425-255-0427",
            "fax_number": "425-255-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17422 108TH AVE SE",
            "address_2": "101",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555400",
            "telephone_number": "425-255-0427",
            "fax_number": "425-255-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2011-05-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER PRACTITIONER",
        "authorized_official_telephone_number": "425-255-0427",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "2219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; 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.