Provider Demographics
NPI:1346743754
Name:DR. KELLYN MISSET ND, LAC, PLLC
Entity Type:Organization
Organization Name:DR. KELLYN MISSET ND, LAC, PLLC
Other - Org Name:CLARITY INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISSET
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:203-521-1690
Mailing Address - Street 1:755 MAIN ST STE 8B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2830
Mailing Address - Country:US
Mailing Address - Phone:203-304-6043
Mailing Address - Fax:877-824-7779
Practice Address - Street 1:755 MAIN ST STE 8B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2830
Practice Address - Country:US
Practice Address - Phone:206-547-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center