JACK J. CLARK, D.C.P.C.
NPI 1083820302
Chiropractor in Fort Wayne, IN
About Jack J. Clark, D.c.p.c. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACK J. CLARK, D.C.P.C. (NPI 1083820302) is a healthcare organization registered as a chiropractor in Fort Wayne, Indiana and active in the NPI registry since May 2007. The organization lists Valerie Badiac, Office Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jack J. Clark, D.c.p.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Jack J. Clark, D.C.P.C., which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jack J. Clark, D.C.P.C.'s NPI number?
The NPI number for Jack J. Clark, D.C.P.C. is 1083820302. It was assigned to this organization in the NPPES registry on May 15, 2007.
Where is Jack J. Clark, D.C.P.C. located?
Jack J. Clark, D.C.P.C. is located at 6015 E State Blvd, Fort Wayne, IN 46815. The listed phone number is (260) 486-1886.
What is Jack J. Clark, D.C.P.C.'s specialty?
The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.
Is Jack J. Clark, D.C.P.C. enrolled in Medicare?
Yes. Jack J. Clark, D.C.P.C. is registered in the Medicare PECOS enrollment system.
When is Jack J. Clark, D.C.P.C.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Indiana, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Jack J. Clark, D.C.P.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Chiropractic) reassigns their Medicare billing to Jack J. Clark, D.C.P.C.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Jack J. Clark, D.C.P.C. was last updated on June 27, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jack J. Clark, D.c.p.c. · NPI 1083820302
Chiropractor organization in Fort Wayne, Indiana. Organization record, active in the CMS NPPES registry since May 15, 2007.
## Identity
- **NPI:** 1083820302 (Entity type: Organization)
- **Enumerated:** May 15, 2007
- **Primary specialty:** Chiropractor · taxonomy 111N00000X
- **Organization subpart:** No
- **Authorized official:** Valerie Badiac, OFFICE MANAGER
## Practice location
- **Address:** 6015 E STATE BLVD, Fort Wayne, IN 46815-7638
- **Phone:** (260) 486-1886
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, Indiana, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Chiropractic) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 27, 2008
- **Other identifiers:** Medicare PIN 197110 (IN); Medicaid 100289660A (IN)
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Source: [NPI Profile](https://npiprofile.com/npi/1083820302) · Data from the CMS NPPES public registry.