Provider Demographics
NPI:1124143961
Name:YODER, PATRICIA LYNN (DC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:YODER
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 1:845 TEAGUE TRL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3104
Mailing Address - Country:US
Mailing Address - Phone:352-751-5083
Mailing Address - Fax:352-751-5376
Practice Address - Street 1:845 TEAGUE TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3104
Practice Address - Country:US
Practice Address - Phone:352-751-5083
Practice Address - Fax:352-751-5376
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU27926Medicare UPIN
FL22726Medicare ID - Type UnspecifiedPROVIDER NUMBER