Provider Demographics
NPI:1487310892
Name:STIEREN, CLARK (DC)
Entity type:Individual
Prefix:
First Name:CLARK
Middle Name:
Last Name:STIEREN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DAGGETT CIR
Mailing Address - Street 2:
Mailing Address - City:PONCE INLET
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7032
Mailing Address - Country:US
Mailing Address - Phone:301-467-1173
Mailing Address - Fax:772-413-7025
Practice Address - Street 1:104 SE LONITA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3447
Practice Address - Country:US
Practice Address - Phone:772-463-2344
Practice Address - Fax:772-463-9565
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty