Provider Demographics
NPI:1063020980
Name:YKTC CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:YKTC CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:YEISY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-972-2672
Mailing Address - Street 1:1830 RADIUS DR APT 705
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-7711
Mailing Address - Country:US
Mailing Address - Phone:786-972-2672
Mailing Address - Fax:
Practice Address - Street 1:1830 RADIUS DR APT 705
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-7711
Practice Address - Country:US
Practice Address - Phone:786-972-2672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty