Provider Demographics
NPI:1871929000
Name:CLARK, RICHARD H (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
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 1:462 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-6544
Mailing Address - Country:US
Mailing Address - Phone:814-432-5061
Mailing Address - Fax:
Practice Address - Street 1:462 WARREN RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-6544
Practice Address - Country:US
Practice Address - Phone:814-432-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000902L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor