Active NPI
Elyssia Mae Clark, DC
- Chiropractor
- Arnold, MO
National Provider Identifier
1861253965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2023050836
- Practice address
- 1804 Jeffco Blvd
Arnold, MO 63010-2719 - Phone
- (636) 296-8123
- Fax
- (636) 296-1900
- NPI assigned
- Jan 17, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2023050836 | MO | Primary |
Addresses
Primary practice location
1804 Jeffco Blvd
Arnold, MO 63010-2719
Mailing address
1804 Jeffco Blvd
Arnold, MO 63010-2719
Phone (636) 296-8123
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705536000000",
"number": "1861253965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 JEFFCO BLVD",
"city": "ARNOLD",
"state": "MO",
"postal_code": "630102719",
"telephone_number": "636-296-8123",
"fax_number": "636-296-1900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1804 JEFFCO BLVD",
"city": "ARNOLD",
"state": "MO",
"postal_code": "630102719",
"telephone_number": "636-296-8123",
"fax_number": "636-296-1900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ELYSSIA",
"middle_name": "MAE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-17",
"last_updated": "2024-01-18",
"certification_date": "2024-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "2023050836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arnold, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.