Healthcare Provider Details

I. General information

NPI: 1659625432
Provider Name (Legal Business Name): YEOUM CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N BETHLEHEM PIKE SUITE S110
LOWER GWYNEDD PA
19002-1427
US

IV. Provider business mailing address

1600 N BETHLEHEM PIKE SUITE S110
LOWER GWYNEDD PA
19002-1427
US

V. Phone/Fax

Practice location:
  • Phone: 215-628-0304
  • Fax: 215-628-0306
Mailing address:
  • Phone: 215-628-0304
  • Fax: 215-628-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. TAESUN YEOUM
Title or Position: OWNER
Credential: D.C.
Phone: 215-628-0304