Tyler Keith Clark, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

33482 Issued in CA

Practice address

819 N Harbor Dr Ste 100
Redondo Beach, CA 90277-2086

Phone

(712) 208-0062

NPI assigned

Mar 11, 2016

Sex

Male

Sole proprietor

Yes

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 CA

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eshghi Chiropractic IncGroup PAC ID 8426317934, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eshghi Chiropractic Inc

  dba San Pedro Chiropractic Clinic

  • Chiropractor
  • San Pedro, CA
  • NPI 1952813602
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1457654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473724800000",
    "number": "1730540295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 N HARBOR DR STE 100",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "90277",
            "telephone_number": "712-208-0062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 N HARBOR DR STE 100",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902772086",
            "telephone_number": "712-208-0062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TYLER",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-11",
        "last_updated": "2016-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "33482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Redondo Beach
• Ann M Clark, O.D.
• Catalina Francesca Betty Clark, LM, CPM
• Heather Marie Dubbert Clark, MA, LMFT
• Nathan Clark, DC
• Anne Louise Clary, MFT
• Clear Recovery Center, LLC (Clear Inc. Residential)
• Clear Recovery Center, LLC (Clear Behavioral Health)
• Clear Recovery Center, LLC (Clear Behavioral Health)
• Clear Recovery Center, LLC (Clear Behavioral Health)

• Chiropractor in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.