Provider Demographics
NPI:1093946402
Name:YEOMANS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:YEOMANS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-289-7778
Mailing Address - Street 1:105 S CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-4813
Mailing Address - Country:US
Mailing Address - Phone:478-289-7778
Mailing Address - Fax:478-289-7776
Practice Address - Street 1:105 S CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-4813
Practice Address - Country:US
Practice Address - Phone:478-289-7778
Practice Address - Fax:478-289-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJXRMedicare UPIN