Clark, Diane Marie
Clark, Diane Marie is an individual health care provider with primary practice located at 4705 S Clyde Morris Blvd , Port Orange FL 32129-4103. She recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as her primary health care specialty. Clark, Diane Marie can be contacted via phone (386) 763-2728.Contact Information
Primary practice address
4705 S Clyde Morris Blvd
Port Orange FL 32129-4103
Phone: (386) 763-2728
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | CH5971 | Florida |
Profile Details
| NPI number | 1306994637 |
|---|---|
| LBN Legal business name | Clark, Diane Marie |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 5th, 2007 |
| Last updated | Dec 19th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306994637 | NPPES |
| Florida | Other | 22574 | BCBS |
| Florida | Other | P00706874 | BCBS |
| Florida | MEDICAID | 001509400 | BCBS |
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