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 1:13020 LIVINGSTON RD STE 14
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5023
Mailing Address - Country:US
Mailing Address - Phone:239-263-3330
Mailing Address - Fax:
Practice Address - Street 1:13020 LIVINGSTON RD STE 14
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-5023
Practice Address - Country:US
Practice Address - Phone:239-263-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor