=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972373868
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARYN O'BANNON DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2024
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13020 LIVINGSTON RD STE 14
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34105-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-3330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13020 LIVINGSTON RD STE 14
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34105-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-3330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH13689
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------