DR. JACK J CLARK D.C.
NPI 1902881014
Chiropractor in Fort Wayne, IN
About Dr. Jack J Clark D.c. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. JACK J CLARK D.C. (NPI 1902881014) is an individual chiropractor in Fort Wayne, Indiana, licensed in Indiana (08000717A) and active in the NPI registry since December 2005. He is a graduate of Western States College Of Chiropractic (1980).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 4
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Jack J Clark D.c. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Clark's NPI number?
The NPI number for Jack Clark is 1902881014. It was assigned to this individual provider in the NPPES registry on December 12, 2005.
Where is Jack Clark located?
Jack Clark practices at 6015 E State Blvd, Fort Wayne, IN 46815. The listed phone number is (260) 486-1886.
What is Jack Clark's specialty?
The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.
Is Jack Clark enrolled in Medicare?
Yes. Jack Clark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
When was this NPI record last updated?
The NPPES record for Jack Clark was last updated on June 22, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Dr. Jack J Clark, D.C. · NPI 1902881014
Chiropractor provider in Fort Wayne, Indiana. Individual provider, active in the CMS NPPES registry since December 12, 2005.
## Identity
- **NPI:** 1902881014 (Entity type: Individual)
- **Enumerated:** December 12, 2005
- **Primary specialty:** Chiropractor · taxonomy 111N00000X
- **State license:** 08000717A (Indiana)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 6015 E STATE BLVD, Fort Wayne, IN 46815-7638
- **Phone:** (260) 486-1886
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Medical school:** Western States College Of Chiropractic, class of 1980
## Record status
- **NPPES last updated:** June 22, 2010
- **Other identifiers:** Other 000000086699 (IN); Medicare UPIN T35288 (IN); Medicare PIN 197110 (IN); and 1 more
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Source: [NPI Profile](https://npiprofile.com/npi/1902881014) · Data from the CMS NPPES public registry.