Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1721 | MN |
Y | 111NN0400X | Neurology | 1721 | MN |
NPI | 1437278942 |
---|---|
Provider Name | Dr. Donald C Clark |
First Address | Eagan, MN 55122-4049 |
Second Address | Eagan, MN 55122-4049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 01/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
645527100 | (05) | MN |