Provider Demographics
NPI:1447512231
Name:CLARK, CHASE NATHANIAL (DC)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:NATHANIAL
Last Name:CLARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20307 VIKING AVE NW
Mailing Address - Street 2:STE #102
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:360-697-3737
Mailing Address - Fax:360-779-6337
Practice Address - Street 1:20307 VIKING AVE NW
Practice Address - Street 2:STE #102
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-697-3737
Practice Address - Fax:360-779-6337
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60282066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor