Eric B Clark Jr., DC,CCMA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR009974 Issued in GA

Practice address

10725 Abercorn St Apt 143
Savannah, GA 31419-1441

Phone

(912) 996-0961

NPI assigned

May 2, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: eric.clark.p1@direct.aicaorthopedics.nextgenshare.com

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.

• Clark Chiropractic and Wellness Care, LLC

  • Chiropractor
  • Savannah, GA
  • NPI 1710476098
  NPD (past)

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

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1912496282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10725 ABERCORN ST APT 143",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314191441",
            "telephone_number": "912-996-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10725 ABERCORN ST APT 143",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314191441",
            "telephone_number": "912-996-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ERIC",
        "middle_name": "B",
        "name_suffix": "Jr.",
        "credential": "DC,CCMA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-02",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR009974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "CHIR009974",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarafaith Home Health
• Clark Chiropractic and Wellness Care, LLC
• Tracey Amanda Clark-Johnson
• Alexandra Nicole Clark
• Carly Virginia Clark
• Jarlexia Clark, RBT
• Lisa Landers Clark, LPC
• Maya R Clark, CCC-SLP
• Rebecca Clark
• Shamira Malik Clark, PCT

• Chiropractor in Savannah, GA
• Providers in Savannah, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.