DR. JACK J CLARK (D.C.) – Chiropractor, NPI 1902881014

DR. JACK J CLARK (D.C.) is a healthcare provider. based in Fort wayne, Indiana. specializing in CHIROPRACTIC. They hold the professional credentials D.C.. They hold a License No. 08000717A (IN). The NPI Number for DR. JACK J CLARK (D.C.) is 1902881014

Main info

Male
Sole Proprietor
46 Years Of Experience
Accepts Medicare Assignment
Name
DR. JACK J CLARK (D.C.)
NPI
1902881014
Phone
(260) 486-1886
Address
6015 E STATE BLVD
Enumeration Date
12 December 2005
Last Update Date
22 June 2010

Doctor Profile

Medical School Name
WESTERN STATES COLLEGE OF CHIROPRACTIC
Secondary Phone
2604861886
Graduation Year
1980 (46 years ago)
PAC ID
4183806193
Professional Enrollment ID
I20110314000056
Address ID
IN468157638FO6015XBLVD400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

770 CHIROPRACTIC in IN

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Provider Addresses for DR. JACK J CLARK (D.C.)

  • 6015, East State Boulevard, Fort Wayne, Allen County, Indiana, 46815, United States

    FORT WAYNE, IN 468157638

    Phone: (260) 486-1886

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2011-03-14

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20110314000056IChiropracticINTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
98941Chiropractic manipulative treatment, 3-4 spinal regions26845$0
View full utilization report →

Insurance plans in this area (ZIP 46815)

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Reviews

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Frequently asked questions

What is the registry number for DR. JACK J CLARK (D.C.)?
The registry entry for DR. JACK J CLARK (D.C.) shows NPI 1902881014.
Quick check: is DR. JACK J CLARK (D.C.) active?
Public NPPES data shows DR. JACK J CLARK (D.C.) with an active NPI status right now.
What does the directory say DR. JACK J CLARK (D.C.) does?
Insurance directories may phrase it differently, but here DR. JACK J CLARK (D.C.) maps to Chiropractor. Clinical services aligned with this taxonomy classification.
Can patients visit DR. JACK J CLARK (D.C.) in Fort Wayne, Indiana?
For routing, start with Fort Wayne, Indiana for DR. JACK J CLARK (D.C.), then verify phone and hours locally.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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