NPI 1205043528

David James Clark

Practitioner Orthotic Fitter Saint Paul, MN

Practice location

Address: 2200 University Ave W #114, Saint Paul, MN 55114-1839
Phone: (651) 644-5800
Mailing address: 11424 Quincy St NE, Blaine, MN 55434-2931

Registered specialties

Orthotic Fitter Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225000000X Licence 1175 (MN)

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Registry record

NPI: 1205043528
Entity type: Individual
Sex (as registered): Male
NPI issued: 17 May 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.