Active NPI
Jordan Shaye Clark, DC
- Chiropractor
- Port St Lucie, FL
National Provider Identifier
1831894906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH14473
- Practice address
- 8108 Carnoustie PL
Port St Lucie, FL 34986-3317 - Phone
- (732) 850-8304
- NPI assigned
- Mar 30, 2023
- Sex
- Female
- 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 | CH14473 | FL | Primary |
Addresses
Primary practice location
8108 Carnoustie PL
Port St Lucie, FL 34986-3317
Mailing address
8108 Carnoustie PL
Port St Lucie, FL 34986-3317
Phone (732) 850-8304
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 |
|---|---|---|---|
| CH14473 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680134400000",
"number": "1831894906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8108 CARNOUSTIE PL",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349863317",
"telephone_number": "732-850-8304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8108 CARNOUSTIE PL",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349863317",
"telephone_number": "732-850-8304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JORDAN",
"middle_name": "SHAYE",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-30",
"last_updated": "2023-03-30",
"certification_date": "2023-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH14473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.