Healthcare Provider Details

I. General information

NPI: 1306767850
Provider Name (Legal Business Name): EMILY CLARK LAC, DACCHM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 SHALLOWFORD RD STE 102
CHATTANOOGA TN
37421-7218
US

IV. Provider business mailing address

408 S SAINT MARKS AVE
CHATTANOOGA TN
37412-2962
US

V. Phone/Fax

Practice location:
  • Phone: 423-702-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number585
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: