=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134470081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YER CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2012
-----------------------------------------------------
Last Update Date | 10/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5266 HOLLISTER AVE SUITE 215
-----------------------------------------------------
City | GOLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93111-2037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-403-4877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5266 HOLLISTER AVE SUITE 215
-----------------------------------------------------
City | GOLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93111-2037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-403-4877
-----------------------------------------------------
Fax | 951-880-0094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | YER TON CHA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 805-403-4877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 32188
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------