=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922562230
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILIE E CLARE DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2019
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 STATE ST STE 106
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67010-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-350-7515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 DEBRA CIR
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67010-9438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-350-7515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 01-06120
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 14018
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------