Dominique Clark, DC
Individual provider Active NPI Chiropractor · Park Ridge, NJ
NPI 1932071503 · NPPES record last updated Sep 22, 2025
Key facts
- NPI
- 1932071503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 38MC00813900 (NJ)
- Practice address
- 17 Hawthorne Ave
Park Ridge, NJ 07656-1212 - Phone
- (201) 501-8984
- NPI assigned
- Sep 22, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38MC00813900 | NJ | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 38MC00813900 | NJ | Yes |
Addresses
Primary practice location
17 Hawthorne Ave
Park Ridge, NJ 07656-1212
Mailing address
17 Hawthorne Ave
Park Ridge, NJ 07656-1212
Phone (201) 501-8984
Other providers in Park Ridge, NJ
- Arlene Castillo
- Carolyn Mary Cerswell
- Cgganjhos LLC
- Children'S Aid and Family Services, Inc.
- Children'S Aid and Family Services, Inc.
- Elana T Clark
- Glenn Nicholas Collazo
- Curalta Medical LLC
- Curalta Medical LLC
- Michele S Cushing-Hennessy
All providers in Park Ridge, NJ · Chiropractor in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.