Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5172 | NC |
N | 111NI0013X | Independent Medical Examiner | 5171 | NC |
N | 111NI0013X | Independent Medical Examiner | 5172 | NC |
N | 175F00000X | Naturopath |
NPI | 1053615989 |
---|---|
Provider Name | Dr. Deirdre V Clark |
First Address | Charlotte, NC 28262-0039 |
Second Address | Charlotte, NC 28262-1042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2011 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5172 | CHIROPRACTIC LICENSE (01) | NC |