Provider Demographics
NPI:1922494129
Name:YELLOW SPRINGS CHIROPRATIC II, LLC
Entity Type:Organization
Organization Name:YELLOW SPRINGS CHIROPRATIC II, LLC
Other - Org Name:YELLOW SPRINGS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRUSHON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-508-8010
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:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty