Provider Demographics
NPI:1497221410
Name:YOURCHIRO NSB
Entity Type:Organization
Organization Name:YOURCHIRO NSB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEARNED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-216-2361
Mailing Address - Street 1:1970 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-8349
Mailing Address - Country:US
Mailing Address - Phone:480-216-2361
Mailing Address - Fax:
Practice Address - Street 1:1970 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8349
Practice Address - Country:US
Practice Address - Phone:480-216-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH9829OtherSTATE LISCENSE