Provider Demographics
NPI:1902834047
Name:YARBOROUGH, MARK S (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:YARBOROUGH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14330 E WADE HAMPTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 E WADE HAMPTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1547
Practice Address - Country:US
Practice Address - Phone:864-877-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-09-16
Deactivation Date:2010-11-24
Deactivation Code:
Reactivation Date:2011-02-02
Provider Licenses
StateLicense IDTaxonomies
SC1182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor