Healthcare Provider Details

I. General information

NPI: 1376855486
Provider Name (Legal Business Name): DANIEL S YACHTER D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3577 LAKE EMMA RD SUITE #121
LAKE MARY FL
32746-2056
US

IV. Provider business mailing address

PO BOX 952109
LAKE MARY FL
32795-2109
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-2277
  • Fax: 407-333-3729
Mailing address:
  • Phone: 407-333-2277
  • Fax: 407-333-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: