DR. DIANE MARIE CLARK (NPI# 1306994637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306994637 |
| Entity Type | Individual |
| Full Name | DR. DIANE MARIE CLARK |
| Other Name | DR. DIANE MARIE CLARK |
| Credential | D.C. |
| Practice Address |
4705 S Clyde Morris Blvd Port Orange FL 32129-4103 |
| Practice Telephone | 3867632728 |
| Mailing Telephone | 3867632728 |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2012-12-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | CH5971 | FL | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 001509400 | 05 | |
| FL | RAILROAD MEDICARE | P00706874 | 01 |
| FL | BCBS | 22574 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841767449 | Diane Clark | Registered Nurse | 8219 Golden Hbr, Missouri City, TX 77459-6905 | 2018-11-01 |
| 1669612644 | Diane M Clark | Counselor | 1557 Brandon Sq, Lawrenceville, GA 30044-3016 | 2009-03-03 |
| 1922563139 | Diane Faith Clark | Psychologist | 25631 Peter A Hartman Way, Mission Viejo, CA 92691-3142 | 2019-02-01 |
| 1952763377 | Diane Clark | Registered Nurse | 1118 F St, Lewiston, ID 83501-1930 | 2016-03-24 |
| 1225419096 | Diane Clark | Social Worker | 1115 Westport Dr Ste D2, Manhattan, KS 66502-2871 | 2015-06-17 |
| 1164832887 | Diane Clark | Counselor | 233 S Quintana Dr, Anaheim, CA 92807 | 2014-05-02 |
| 1558634980 | Diane Clark | Pharmacist | 3639 Crater Lake Hwy, Medford, OR 97504-9259 | 2012-02-15 |
| 1881863488 | Diane K Clark | Nurse Practitioner | 9427 Sw Barnes Rd, Ste 595, Portland, OR 97225-6640 | 2008-02-27 |
| 1841406261 | Diane E. Clark | Counselor | 200 Washington St, Suite 205, Watertown, NY 13601-3335 | 2007-05-15 |
| 1306941166 | Diane Maxine Clark | Physical Therapist | 13560 Wayzata Blvd, Minnetonka, MN 55305-1850 | 2006-09-14 |
| Street Address |
4705 S CLYDE MORRIS BLVD |
| City | PORT ORANGE |
| State | FL |
| Zip Code | 32129-4103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760459200 | Christopher M Varnum | Chiropractor | 4705 S Clyde Morris Blvd, Palmer Chiropractic Clinic, Port Orange, FL 32129-4103 | 2006-03-03 |
| 1619277506 | John Wesley Humbert | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2010-10-26 |
| 1275849929 | Shannon St Amant | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2010-08-19 |
| 1710204219 | Matthew Dale Richardson | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2010-04-23 |
| 1457677635 | Misty Dawn Lagasse | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2010-04-13 |
| 1013232875 | Carl Francesco Stephens | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2010-04-05 |
| 1881920221 | Je'ne Nycole Jordahl | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2009-10-20 |
| 1205033925 | Jessie Miller | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2007-06-27 |
| 1477759447 | Diva Soares | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2007-06-26 |
| 1225158991 | Michael R Hochberg | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2007-03-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982179818 | Port Orange Modern Dentistry, Pa | Dentist | 1765 Dunlawton Ave., Suite 103, Port Orange, FL 32129 | 2018-10-08 |
| 1932698131 | Brittany Michele Claude | Behavioral Analyst | 4647 Clyde Morris Blvd Suite 501, Port Orange, FL 32129 | 2018-05-03 |
| 1760919468 | Makayla Earl | Behavior Technician | 1557 Town Park Dr., Port Orange, FL 32129 | 2017-05-12 |
| 1184157968 | Katie Lynn Weisz | Physician Assistant | 3635 South Clyde Morris Blvd, Suite 100, Port Orage, FL 32129 | 2017-04-07 |
| 1285178319 | Mallory Driggers | Counselor | 980 Canal View Blvd Apt F7, Port Orange, FL 32129 | 2016-12-08 |
| 1912321654 | Edward L. Staudt Dds & Kenneth L. Staudt Dds, Mph | Dentist | 944 Bridgewater Dr., Suite 2-b, Port Orange, FL 32129 | 2014-02-18 |
| 1538411731 | Roberta Ann Gilmartin | Specialist | 1048 W Samms Ave, Port Orange, FL 32129 | 2012-10-11 |
| 1679892996 | Pamela Kirby Pa | Clinic/Center | 4606 South Clyde Morris Boulevard, Suite 1j, Port Orange, FL 32129 | 2010-05-26 |
| 1326376385 | Connie Jeanne Bodnarik | Physical Therapy Assistant | 3780 S Clyde Morris Blvd Apt 1206, Port Orange, FL 32129 | 2009-12-02 |
| 1669645057 | American Family & Sports Chiropractic Center Inc | Chiropractor | 4649 Clyde Morris Blvd Unit 609, Port Orange, FL 32129 | 2008-04-08 |
| Find all providers in zip 32129 | ||||
| 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 |
|---|---|---|---|---|
| 1558911818 | Space Coast Spine LLC. | Chiropractor | 1402 Dunlawton Ave Ste 2b, Port Orange, FL 32127-2917 | 2019-09-18 |
| 1114571163 | Nicole Troyer | Chiropractor | 4462 Tumbleweed Trl, Port Orange, FL 32127-4984 | 2019-07-29 |
| 1336603083 | Michael Sambursky | Chiropractor | 1402 Dunlawton Ave # 2b, Port Orange, FL 32127-2917 | 2019-01-28 |
| 1871069732 | Coastal City Chiropractic Center LLC | Chiropractor | 4550 Clyde Morris Blvd Ste D, Port Orange, FL 32129-4080 | 2018-10-18 |
| 1639654387 | Jennifer Chelsie Demaio | Chiropractor | 4550 Clyde Morris Blvd, Ste D, Port Orange, FL 32129-4080 | 2018-09-28 |
| 1134601602 | Kathleen Ann Rooney | Chiropractor | 813 Little Town Rd, Port Orange, FL 32127-9232 | 2018-08-31 |
| 1417463894 | Lowe Chiropractic and Wellness Center | Chiropractor | 3780 S Nova Rd Ste 6, Port Orange, FL 32129-4203 | 2017-12-20 |
| 1427563915 | Kristal Xiomara Perez | Chiropractor | 862 Stonybrook Cir, Port Orange, FL 32127-4211 | 2017-12-06 |
| 1912410838 | Nicolle J Schultze | Chiropractor | 3959 S Nova Rd Ste 9, Port Orange, FL 32127-4900 | 2017-11-14 |
| 1023544640 | Garrett Chiropractic LLC | Chiropractor | 1409 Royal Grove Ln, Port Orange, FL 32129-8998 | 2017-05-02 |
| Find all providers in PORT ORANGE | ||||
| City | PORT ORANGE |
| Zip Code | 32129 |
Please comment or provide details below to improve the information on DR. DIANE MARIE 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.