Provider Demographics
NPI:1083141451
Name:CLEMENTS, TRICIA (DC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 E SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2052
Mailing Address - Country:US
Mailing Address - Phone:417-887-8075
Mailing Address - Fax:417-887-8535
Practice Address - Street 1:3021 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2052
Practice Address - Country:US
Practice Address - Phone:417-887-8075
Practice Address - Fax:417-887-8535
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017015142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor