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General NPI Number Information
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NPI Number | 1336779529
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Entity Type | Organization
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Legal Business Name | WHOLE LIFE FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 8872 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44484-2350
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Country | US
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Telephone | 724-944-8539
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Fax |
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Provider Business Mailing Address
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Address Line | 111 CAROLINE AVE
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City | HUBBARD
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State | OH
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Zip | 44425-1734
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Country | US
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Telephone | 724-944-8539
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELLY JO YERGAN
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Credential | D.C.
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Telephone | 724-944-8539
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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 |
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License Number State |
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