Doctor Name: | THEODORE JEFFREY CLARK |
NPI Number: | 1861705964 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.C. |
License Number: | 2219 |
Business Practice Address: | 17422 108th Ave Se #101 Renton, WA - 980555400 |
Business Phone Number: | 4252550427 |
Business Fax Number: | 4252551066 |
Mailing Address: | 17422 108th Ave Se, 101 RENTON |
State: | WA |
Postal Code: | 980555400 |
Phone Number: | 4252550427 |
Fax Number: | 4252551066 |
NPI Enumeration Date: | 07/17/2010 |
NPI Last Update Date: | 07/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 2219 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |