Provider Demographics
NPI:1972373868
Name:O'BANNON, TARYN (DC)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:O'BANNON
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 1:11000 PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-9721
Mailing Address - Country:US
Mailing Address - Phone:863-414-0360
Mailing Address - Fax:
Practice Address - Street 1:18070 S TAMIAMI TRL STE 11
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4602
Practice Address - Country:US
Practice Address - Phone:352-678-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor