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.

Only the licensee should change information on this site. By entering information on this site, you are representing that you are the person whose information is being changed.

Name as it appears on your license
Last Name: (Required)
First Name: (Required)
Middle Initial:
License Number: (Required)
Email:
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:

If you would like an updated copy of your license with your new address on it please check here:

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