Jeffery Clark, D.C.
Individual provider Active NPI Chiropractor · Cary, IL
NPI 1992867709 · NPPES record last updated Mar 5, 2008
Key facts
- NPI
- 1992867709
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038-008727 (IL)
- Practice address
- 3202 Northwest Hwy
Ste E
Cary, IL 60013-3507 - Phone
- (847) 516-8000
- Fax
- (847) 516-8959
- NPI assigned
- Dec 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- National College of Chiropractic, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3202 Northwest Hwy
Suite E
Cary, IL 60013-3500
Phone (847) 516-8000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070813000066 | IL | Practitioner - Chiropractic | 1456442961 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-008727 | IL | MD | Chiropractor |
| 3585 | IL | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Suburban Family Chiropractic, LTD. | Chiropractor | Current |
Accepting new patients |
Locations
3202 Northwest Hwy
Ste E
Cary, IL 60013
Phone (847) 516-8000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-008727 | IL | Yes |
| Sports Physician Chiropractor | 111NS0005X | 3585 | IL |
Addresses
Primary practice location
3202 Northwest Hwy
Ste E
Cary, IL 60013-3507
Mailing address
3202 Northwest Hwy
Ste E
Cary, IL 60013-3507
Phone (847) 516-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05622903 | Other | IL | BLUE CROSS BLUE SHIELD |
Other providers in Cary, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.