NPIMap

Organization Active NPI

Clark Chiropractic Clinic

  • Chiropractor
  • Odessa, TX
National Provider Identifier
1952555211
Registry record updated Nov 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5928 Issued in TX
Legal business name
CLARK CHIROPRACTIC CLINIC
Practice address
6301 Eastridge Rd
Odessa, TX 79762-5045
Phone
(432) 337-5553
Fax
(432) 337-6183
NPI assigned
Nov 12, 2008
Last updated
Nov 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2008

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

Authorized official

Name
Mr. James William Kirk, D CNPI 1891856514
Title
President/Ceo
Phone
(432) 337-5553

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 8532 TX
Chiropractor 111N00000X 7347 TX
Chiropractor 111N00000X 2256 TX
Chiropractor 111N00000X 5928 TX Primary

Addresses

Primary practice location

6301 Eastridge Rd
Odessa, TX 79762-5045

Mailing address

6301 Eastridge Rd
Odessa, TX 79762-5045
Phone (432) 337-5553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090318000585 TX Part B Supplier - Clinic/Group Practice 2365509379 Receives reassigned benefits from 6 practitioners
Practice locations: Odessa, TX; Rankin, TX

National Provider Directory

National Provider Directory

Locations

6301 Eastridge Rd
Odessa, TX 79762
Phone (432) 337-5553

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226448000000",
    "number": "1952555211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 EASTRIDGE RD",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625045",
            "telephone_number": "432-337-5553",
            "fax_number": "432-337-6183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 EASTRIDGE RD",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625045",
            "telephone_number": "432-337-5553",
            "fax_number": "432-337-6183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK CHIROPRACTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-12",
        "last_updated": "2008-11-12",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "432-337-5553",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "8532",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "7347",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "2256",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "5928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.