DR. DEIRDRE V CLARK DC ND CHT CCRA NPI 1053615989

NPI Information

NPI: 1053615989
Provider Name: DR. DEIRDRE V CLARK, DC, ND, CHT, CCRA
Classification: Chiropractor - 111N00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
10926 DAVID TAYLOR DR STE 120
CHARLOTTE, NC
ZIP 28262
Phone: (704) 266-3250
Get Directions

DR. Deirdre V Clark, DC, ND, CHT, CCRA is a chiropractor in Charlotte, NC with 24 years of experience. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. DR. Deirdre V Clark, DC, ND, CHT, CCRA NPI is 1053615989. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: SHERMAN COLLEGE OF STRAIGHT CHIROPRACTIC
Graduation Year:2000

The provider's business location address is:

10926 DAVID TAYLOR DR STE 120
CHARLOTTE, NC
ZIP 28262-042
Phone: (704) 266-3250

The NPI 1053615989 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/6/2011 and was last updated on 8/27/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	111N00000X	Chiropractor		5172	NORTH CAROLINA	Yes
2	1744R1102X	Specialist	Research Study			No
3	175F00000X	Naturopath				No
4	171M00000X	Case Manager/Care Coordinator				No
5	111NI0013X	Chiropractor	Independent Medical Examiner	5171	NORTH CAROLINA	No
6	111NI0013X	Chiropractor	Independent Medical Examiner	5172	NORTH CAROLINA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5172	OTHER	NORTH CAROLINA	CHIROPRACTIC LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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