Provider Demographics
NPI:1386183358
Name:ROMAN, YAHAIRA LEE (DC)
Entity Type:Individual
Prefix:
First Name:YAHAIRA
Middle Name:LEE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-3637
Mailing Address - Country:US
Mailing Address - Phone:386-290-9822
Mailing Address - Fax:
Practice Address - Street 1:804 DUNLAWTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4931
Practice Address - Country:US
Practice Address - Phone:386-492-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11678111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician