Stephanie Clark, DC

Primary specialty

Nutrition ChiropractorTaxonomy code 111NN1001X

License

8450809 Issued in NH

Practice address

3 Elmwood Rd
Hancock, NH 03449-5629

Phone

(603) 525-3335

Fax

(866) 611-5548

NPI assigned

Jun 10, 2005

Last updated

Jan 10, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Back to Life LLC

  • Chiropractor
  • Hancock, NH
  • NPI 1093038010
  Authorized official Same address or phone
• Texas Treatment Services LLC

  dba Brentwood Treatment Services

  • Methadone Clinic
  • Fort Worth, TX
  • NPI 1932377082
  NPD (past)

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578614400000",
    "number": "1851395453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 ELMWOOD RD",
            "city": "HANCOCK",
            "state": "NH",
            "postal_code": "034495629",
            "telephone_number": "603-525-3335",
            "fax_number": "866-611-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 ELMWOOD RD",
            "city": "HANCOCK",
            "state": "NH",
            "postal_code": "034495629",
            "telephone_number": "603-525-3335",
            "fax_number": "866-611-5548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHANIE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-10",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "38-010216",
            "primary": false
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "NH",
            "license": "8450809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "210028",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "0019272201",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "08132071",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Back to Life LLC
• Maryanne Bates, RPH
• Jason Adam Bennett, APRN
• Deborah Jean Clark
• Eden Living PLLC
• Elizabeth Lent, LMHC
• Mercurius Psychiatric Services LLC
• Kathy Jo Murphy, LCMHC

• Nutrition Chiropractor in Hancock, NH
• Providers in Hancock, NH by specialty
• Nutrition Chiropractor in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; 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.