Provider Demographics
NPI:1780704825
Name:FULL CIRCLE CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:FULL CIRCLE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-488-8868
Mailing Address - Street 1:1701 SISKIYOU BLVD
Mailing Address - Street 2:#2
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2437
Mailing Address - Country:US
Mailing Address - Phone:541-488-8868
Mailing Address - Fax:541-488-9266
Practice Address - Street 1:1701 SISKIYOU BLVD
Practice Address - Street 2:#2
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2437
Practice Address - Country:US
Practice Address - Phone:541-488-8868
Practice Address - Fax:541-488-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133671Medicare ID - Type UnspecifiedGEORGIA B YOUNG
OR133672Medicare ID - Type UnspecifiedFULL CIRCLE CHIROPRACTIC
ORV07901Medicare UPIN