1831415355 NPI number — DR. ROBERT JOHN CLARKE D.C.

Table of content: DR. ROBERT JOHN CLARKE D.C. (NPI 1831415355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831415355 NPI number — DR. ROBERT JOHN CLARKE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARKE
Provider First Name:
ROBERT
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARKE
Provider Other First Name:
ROBERT
Provider Other Middle Name:
JOHN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831415355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1519 9TH ST
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98270-4600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-658-1987
Provider Business Mailing Address Fax Number:
360-658-5618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1519 9TH ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-658-5618
Provider Business Practice Location Address Fax Number:
360-658-5618
Provider Enumeration Date:
04/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH60145579 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com