Individual
DR. KELLY DARLENE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
70 NW 1ST AVE, LAKE BUTLER, FL 32054-1611
(352) 317-8273
Mailing address
70 NW 1ST AVE, LAKE BUTLER, FL 32054-1611
(352) 317-8273
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CH13101
FL
111NR0400X
Rehabilitation Chiropractor
Primary
CH13101
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201397927
TEXAS STATE
TX
Enumeration date
11/24/2010
Last updated
06/18/2021
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