DR. DEIRDRE V CLARK (NPI# 1053615989) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053615989 |
| Entity Type | Individual |
| Full Name | DR. DEIRDRE V CLARK |
| Credential | DC, ND, CHT, CCRA |
| Practice Address |
10926 David Taylor Dr Ste 120 Charlotte NC 28262-1042 |
| Mailing Address |
10926 David Taylor Dr Ste 120 Charlotte NC 28262-0039 |
| Practice Telephone | 7042663250 |
| Mailing Telephone | 7042663250 |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2020-08-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 5172 | NC | Chiropractic Providers |
| N | 1744R1102X |
Specialist Specialization: Research Study |
Other Service Providers | ||
| N | 175F00000X | Naturopath | Other Service Providers | ||
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
| N | 111NI0013X |
Chiropractor Specialization: Independent Medical Examiner |
5172 | NC | Chiropractic Providers |
| N | 111NI0013X |
Chiropractor Specialization: Independent Medical Examiner |
5171 | NC | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | CHIROPRACTIC LICENSE | 5172 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3000 Midlantic Dr Ste 100, Mount Laurel, NJ 080541513 | 8566072400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336429414 | Deirdre Danielle Clark | Case Manager/Care Coordinator | 2844 Hampton Meadow Dr, Tallahassee, FL 32311-8124 | 2011-08-22 |
| 1144619040 | Deirdre Hemphill Clark | Pharmacist | 95 Spring St, Auburn, ME 04210-5948 | 2015-01-15 |
| 1811251713 | Deirdre M Clark | Nurse Practitioner | 326 Washington St, Norwich, CT 06360-2740 | 2012-06-26 |
| Street Address |
10926 DAVID TAYLOR DR STE 120 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28262-1042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184802241 | Cheryl Lynn Bennett | Psychologist | 10926 David Taylor Dr Ste 120, Charlotte, NC 28262-1042 | 2008-01-31 |
| 1932713401 | Clark Clinical Consulting LLC | Chiropractor | 10926 David Taylor Dr Ste 120, Charlotte, NC 28262-0039 | 2020-09-02 |
| 1881239093 | Southeast Radiology Associates Pllc | Clinic/Center | 10926 David Taylor Dr Ste 120, Charlotte, NC 28262-1042 | 2019-11-12 |
| 1871901843 | Cheryl L Bennett Phd Pllc | Psychologist | 10926 David Taylor Dr Ste 120, Charlotte, NC 28262-1042 | 2014-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366056913 | Aleta Michelle Johnson | Specialist | 9711 David Taylor Dr., Ste. 145, Charlotte, NC 28262 | 2020-09-01 |
| 1275161580 | Londyn Homecare Agency L.l.c | Home Health | 1914j.n. Place, Charlotte, NC 28262 | 2020-03-31 |
| 1154964914 | Abundant Love Home Care Service LLC | In Home Supportive Care | 1981 J.n. Pease Place, Ste 204, Charlotte, NC 28262 | 2019-10-24 |
| 1104399070 | Nattya S Pilgreen | Prosthetist | 410 E Mccullough Drive, Suite 103, Charlotte, NC 28262 | 2019-01-03 |
| 1114404506 | Laura Ida Anthony-getant | Social Worker | 10130 Mallard Creek Road, Ste 300 #333, Charlotte, NC 28262 | 2018-07-27 |
| 1720573587 | Carolinas Center for Ambulatory Dentistry LLC | Dentist | 8415 Medical Plaza Drice, Charlotte, NC 28262 | 2018-06-25 |
| 1598254799 | Cassandra Faye Harding | Nurse Practitioner | 1905 Jn Pease Place Suite 103, Charlotte, NC 28262 | 2018-05-03 |
| 1669960746 | Michael Riley | In Home Supportive Care | 8301 University Exec Park Dr Ste 120, Charlotte, NC 28262 | 2018-04-25 |
| 1568989804 | Bridget Coomber | Behavior Technician | 8420 University Executive Dr Ste 810, Charlotte, NC 28262 | 2017-08-28 |
| 1073037701 | Toshana Daley | Physical Therapist | 8801 Jm Keynes Blvd, Charlotte, NC 28262 | 2017-08-03 |
| Find all providers in zip 28262 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| 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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962001776 | Abigail Plowcha | Chiropractor | 4818 Charlton Ln, Charlotte, NC 28210-2705 | 2020-10-22 |
| 1821602707 | Jose Cruz Troche | Chiropractor | 6253 South Blvd, Charlotte, NC 28217-4440 | 2020-09-08 |
| 1386268233 | Alison Day | Chiropractor | 1533 Pecan Ave, Charlotte, NC 28205-3415 | 2020-06-05 |
| 1881218808 | Evolve Health & Wellness, Pllc | Chiropractor | 3533 Providence Manor Rd, Charlotte, NC 28270-0794 | 2020-06-05 |
| 1306467196 | Lee Christopher Vang | Chiropractor | 6600 Touchwood Dr, Charlotte, NC 28227-8051 | 2020-05-03 |
| 1689200495 | Pannell Wellness Solutions Pllc | Chiropractor | 10716 Overlook Mountain Dr, Charlotte, NC 28216-7812 | 2020-03-13 |
| 1275168288 | Chirosagge, Pllc | Chiropractor | 5200 Park Rd Ste 102-b, Charlotte, NC 28209-3650 | 2020-03-10 |
| 1265064844 | Ka Bao Chang | Chiropractor | 6625 Pawnee Dr, Charlotte, NC 28214-2849 | 2020-02-11 |
| 1538703137 | Gg Chiropractic LLC | Chiropractor | 8811 Blakeney Professional Dr Ste 120, Charlotte, NC 28277-6599 | 2019-11-06 |
| 1205477502 | Family First Chiropractic and Acupuncture Pllc | Chiropractor | 6303 Carmel Rd Ste 101, Charlotte, NC 28226-8281 | 2019-10-08 |
| Find all providers in CHARLOTTE | ||||
Please comment or provide details below to improve the information on DR. DEIRDRE V CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.