Provider Demographics
NPI:1558660837
Name:YELLOW SPRINGS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:YELLOW SPRINGS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUCKWALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-767-7251
Mailing Address - Street 1:233 CORRY ST
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1812
Mailing Address - Country:US
Mailing Address - Phone:937-767-7251
Mailing Address - Fax:937-767-7252
Practice Address - Street 1:233 CORRY ST
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1812
Practice Address - Country:US
Practice Address - Phone:937-767-7251
Practice Address - Fax:937-767-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty