Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X |
| NPI # | 1235771031 |
| LBN Legal business name | CLACK ASSOCIATES, LLC. |
| Authorized official | KEVIN LIEBOLD - (MANAGER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 10/13/2019 |
| Last updated | 10/13/2019 - About 7 years ago |
| Identifiers | n/a |
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