Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH 10888 | FL |
NPI | 1003159237 |
---|---|
Provider Name | Dr. Richard C Clarke |
First Address | Cape Canaveral, FL 32920-5329 |
Second Address | Rockledge, FL 32955-3286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2013 |
Last Update Date | 27/07/2013 |