Provider Demographics
NPI:1801164439
Name:CLARKE, HOLLY LEONTYNE (DC)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LEONTYNE
Last Name:CLARKE
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 1:926 TODD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-4420
Mailing Address - Country:US
Mailing Address - Phone:803-599-3227
Mailing Address - Fax:
Practice Address - Street 1:413 FARRS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-1858
Practice Address - Country:US
Practice Address - Phone:864-246-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor