Healthcare Provider Details

I. General information

NPI: 1477941508
Provider Name (Legal Business Name): YEARGIN CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12721 NEWPORT AVE STE 2
TUSTIN CA
92780-8031
US

IV. Provider business mailing address

12721 NEWPORT AVE STE 2
TUSTIN CA
92780-8031
US

V. Phone/Fax

Practice location:
  • Phone: 657-333-6061
  • Fax:
Mailing address:
  • Phone: 657-333-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16336
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32863
License Number StateCA

VIII. Authorized Official

Name: DR. NATHAN YEARGIN
Title or Position: OWNER
Credential: D.C., L. AC.
Phone: 657-333-6061