Jack J. Clark, D.C.P.C.

LBN: Jack J. Clark, D.C.P.C.
Jack J. Clark, D.C.P.C. is an health care organization with primary practice located at 6015 E State Blvd , Fort Wayne IN 46815-7638. The organization recently has 2 registered licenses in different health care specialties including Chiropractic Providers / Chiropractor, Chiropractic Providers / Rehabilitation. Chiropractic Providers / Chiropractor is the primary health care specialty. Jack J. Clark, D.C.P.C. can be contacted via phone (260) 486-1886, or through Badiac, Valerie via phone (260) 486-1886.

Contact Information

Primary practice address
6015 E State Blvd Fort Wayne IN 46815-7638
Phone: (260) 486-1886
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Badiac, Valerie
Phone: (260) 486-1886

Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 08000717A Indiana
Chiropractic Providers / Rehabilitation 111NR0400X 08002245A Indiana

Profile Details

NPI number 1083820302
LBN Legal business name Jack J. Clark, D.C.P.C.
DBA Doing business as
Authorized official Badiac, Valerie
Entity Organization
Organization subpart 1 No
Enumeration date May 15th, 2007
Last updated Jun 27th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083820302 NPPES
Indiana MEDICAID 100289660A

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