Provider Demographics
NPI:1851395453
Name:CLARK, STEPHANIE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
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 1:3 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:NH
Mailing Address - Zip Code:03449-5629
Mailing Address - Country:US
Mailing Address - Phone:603-525-3335
Mailing Address - Fax:866-611-5548
Practice Address - Street 1:3 ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:NH
Practice Address - Zip Code:03449-5629
Practice Address - Country:US
Practice Address - Phone:603-525-3335
Practice Address - Fax:866-611-5548
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38-010216111N00000X
NH8450809111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0019272201OtherMEDICARE PTAN
NH08132071OtherBCBS
IL210028OtherMEDICARE PTAN
ILV01582Medicare UPIN