Search › South Carolina › 363L00000X
Kelly Clark
NPI 1639840580 · on the registry since 2021
Practice
- Address
- 11134 Broad River Rd Ste D
Irmo, SC 29063 - Phone
- (803) 732-0920
- Organisation at this address
- The Lab Columbia Llc
Ballentine Pediatrics, Llc
Shady Grove Chiropractic, LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 4
Registry record
- Primary taxonomy
- 363L00000X
363L00000X
- Also registered as
- 390200000X
- Licence states on file
- SC
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2022-03-07
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in South Carolina