Board of Registration for the Healing Arts

Change of Address

Please provide the Missouri State Board of Registration for the Healing Arts with any change in your business and/or home address. Please use the form below to report address changes and/or remove address(es) from your record and click submit.

Click here to report a change of name.

Name as it appears on your license
Last Name: (Required)
First Name: (Required)
Middle Initial:
License Number: (Required)
Email:
Effective Date:
Changes dated in the future won't be changed until the date noted.
Please indicate whether you want information sent to your home or business address. * Required Home
Business

New Business Address
Street (line 1):
Street (line 2):
City:
State:
Zip Code:
Telephone Number:
(Please include area code)

New Home Address
Street (line 1):
Street (line 2):
City:
State:
Zip Code:
Telephone Number:
(Please include area code)

New Additional Location Address
Street (line 1):
Street (line 2):
City:
State:
Zip Code:
Telephone Number:
(Please include area code)

Remove the Following Address from my Record
Street (line 1):
Street (line 2):
City:
State:
Zip Code:

Code
Please type the numbers displayed above in the box below.