MEDICARE: PURITY CHIROPRACTIC CLINIC, LLC

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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1255191474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURITY CHIROPRACTIC CLINIC, LLC

Provider Business Mailing Address
First Line	:	1200 GALTIER ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-4454
Country	:	US
Telephone Number	:	651-621-9204
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 GALTIER ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-4454
Country	:	US
Telephone Number	:	651-621-9204
Fax Number	:	651-666-1808

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. LYLIA JACQUELYN YANG
Credential	:	DC
Telephone Number	:	651-621-9204

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	03/22/2024

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