Provider Demographics
NPI:1568972966
Name:CLARKE, CELESTE A (DC)
Entity Type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:A
Last Name:CLARKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CELESTE
Other - Middle Name:A
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:775 AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5991
Mailing Address - Country:US
Mailing Address - Phone:501-504-6999
Mailing Address - Fax:
Practice Address - Street 1:775 AMITY RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5991
Practice Address - Country:US
Practice Address - Phone:501-504-6999
Practice Address - Fax:501-205-8431
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16292111N00000X
TX13388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor