Provider Demographics
NPI:1720484058
Name:YEARGIN, NATHAN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:YEARGIN
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17251 17TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1963
Mailing Address - Country:US
Mailing Address - Phone:657-333-6061
Mailing Address - Fax:
Practice Address - Street 1:12721 NEWPORT AVE STE 2
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-8031
Practice Address - Country:US
Practice Address - Phone:657-333-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16336171100000X
CA32863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist