Dominique Clark, DC
Chiropractor in Park Ridge, NJ. Individual provider (NPI-1).
NPI number1932071503
StatusActive
Last updated in NPPESSep 22, 2025
Details
- NPI
- 1932071503
- Entity type
- Individual (NPI-1)
- Name
- Dominique Clark
- Credential
- DC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 22, 2025
- Certification date
- Sep 22, 2025
- Last updated
- Sep 22, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | 38MC00813900 | NJ | Yes |
Practice location
17 Hawthorne AvePark Ridge, NJ 07656-1212
Phone 201-501-8984
Mailing address
17 Hawthorne AvePark Ridge, NJ 07656-1212
Phone 201-501-8984
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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