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General NPI Number Information
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NPI Number | 1013076785
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Entity Type | Organization
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Legal Business Name | YADKINVILLE CHIROPRACTIC DC PA
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 204 N STATE ST
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City | YADKINVILLE
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State | NC
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Zip | 27055
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Country | US
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Telephone | 336-679-8500
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Fax | 336-677-8536
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Provider Business Mailing Address
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Address Line | PO BOX 754
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City | YADKINVILLE
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State | NC
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Zip | 27055
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Country | US
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Telephone | 336-679-8500
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Fax | 336-677-8536
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Authorized Official
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Title or Position | OWNER PROVIDER PRESIDENT
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Name | DR. LESLIE L HORNE
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Credential | DC
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Telephone | 336-679-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2864
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License Number State | NC
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