Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Edward Petersen Clack, DO

Individual provider Family Medicine Physician · NPI 1659629053

Dr. Edward Petersen Clack, DO is a Family Practice in Dayton, Ohio. Graduated from At Still University of Health Sciences, College of Osteo Med, Kirksville in 2012, 14 years ago. Practices with Shiloh Family Medicine LLC, a 3-clinician group and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
14
Trained at
At Still University of Health Sciences, College of Osteo Med, Kirksville
Licensed in
OH
In the registry since
2012
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

5900 N Main St Ste 3
Dayton, OH 45415-3198
Phone: (937) 277-9371
Fax: (937) 277-7734
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 34.011463 (OH)

Record details

NPI number1659629053
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorYes
NPI enumeratedAugust 16, 2012
Last updated in NPPESMay 3, 2023
Certification dateMay 3, 2023
Mailing address5900 N Main St Ste 3, Dayton, OH 45415-3198

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Also practisesOSTEOPATHIC MANIPULATIVE MEDICINE
Medical schoolAT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
Graduated 2012 (14 years in practice)
Group practice Shiloh Family Medicine Llc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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