Provider Demographics
NPI:1427135896
Name:YUAN, JIMMY (DC)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:YUAN
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 1:1070 WEST SEAGULL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1705
Mailing Address - Country:US
Mailing Address - Phone:602-319-2232
Mailing Address - Fax:480-452-0921
Practice Address - Street 1:4710 N. 44TH STREET
Practice Address - Street 2:SUITE 187
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6675
Practice Address - Country:US
Practice Address - Phone:602-840-3430
Practice Address - Fax:480-324-0589
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor