Provider Demographics
NPI:1770034308
Name:CLARK, ASHLEA RAYLENE (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEA
Middle Name:RAYLENE
Last Name:CLARK
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 1:10415 SCARLET OAK DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-1329
Mailing Address - Country:US
Mailing Address - Phone:313-753-0994
Mailing Address - Fax:
Practice Address - Street 1:6569 N EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2030
Practice Address - Country:US
Practice Address - Phone:501-687-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor