Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC8097 | TX |
N | 111NS0005X | Chiropractic Sports Physician | DC8097 | TX |
N | 175F00000X | Naturopath |
NPI | 1265503072 |
---|---|
Provider Name | Clayton Lohiau Clark |
First Address | San Antonio, TX 78232 |
Second Address | San Antonio, TX 78232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8A3341 | BCBS (01) | TX |
U72767 | (02) |