Brett Jacob Clark, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2016044966 Issued in MO

Practice address

2718 Forum Blvd Ste 2
Columbia, MO 65203-5451

Phone

(314) 704-1095

Fax

(314) 873-1887

NPI assigned

Jan 4, 2017

Last updated

Mar 14, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Brett Clark's Alternative Way LLC

  • Medical Specialty Clinic/Center
  • Chesterfield, MO
  • NPI 1841722857
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1679018303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2718 FORUM BLVD STE 2",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652035451",
            "telephone_number": "314-704-1095",
            "fax_number": "314-873-1887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2718 FORUM BLVD STE 2",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652035451",
            "telephone_number": "314-704-1095",
            "fax_number": "314-873-1887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRETT",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-04",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2016044966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Columbia (Columbia/Boone County Department of Public Health and Human Services)
• City of Columbia
• Bailey M Clancy, MD
• Adam T. Clapper, MD
• Clark Supported Living
• Brian Lloyd Clark, CRNA
• Carrie Cecilia Clark, CCC-SLP
• Clayton Charles Clark, FNP
• Frank I Clark, MD
• Henry William Clark, M.A., LPC

• Chiropractor in Columbia, MO
• Providers in Columbia, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.