Healthcare Provider Details

I. General information

NPI: 1720484058
Provider Name (Legal Business Name): NATHAN YEARGIN D.C., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12721 NEWPORT AVE STE 2
TUSTIN CA
92780-8031
US

IV. Provider business mailing address

17251 17TH ST STE A
TUSTIN CA
92780-1963
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:
Title or Position:
Credential:
Phone: