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NPI Code Detail

MEDICARE: DR. HOLLY LEONTYNE CLARKE D.C.

MEDICARE: DR. HOLLY LEONTYNE CLARKE D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3691SC

General Provider Information

NPI Number : 1801164439
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HOLLY LEONTYNE CLARKE D.C.
Provider Business Mailing Address
First Line : 926 TODD AVE
Second Line :
City : NORTH AUGUSTA
State : SC
Zip : 29841-4420
Country : US
Telephone Number : 803-599-3227
Fax Number :
Provider Business Practice Location Address
First Line : 413 FARRS BRIDGE RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29617-1858
Country : US
Telephone Number : 864-246-0803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2011
Last Update Date : 12/09/2011

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