Provider Demographics
NPI:1215166574
Name:SURBAUGH, JARED KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:KYLE
Last Name:SURBAUGH
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 1:2105 AMALFI PL STE 102
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-7058
Mailing Address - Country:US
Mailing Address - Phone:304-627-5435
Mailing Address - Fax:304-292-2282
Practice Address - Street 1:ADVANTAGE CHIROPRACTIC, PC
Practice Address - Street 2:1460 KELLY ROAD SUITE 102
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2750
Practice Address - Country:US
Practice Address - Phone:304-627-5435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor