Provider Demographics
NPI:1154548295
Name:JAMES M YEWCHUK CHIROPRACTIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JAMES M YEWCHUK CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:YEWCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-273-5433
Mailing Address - Street 1:3150 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4612
Mailing Address - Country:US
Mailing Address - Phone:541-273-5433
Mailing Address - Fax:541-850-2461
Practice Address - Street 1:3150 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4612
Practice Address - Country:US
Practice Address - Phone:541-273-5433
Practice Address - Fax:541-850-2461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCE CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0600001797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU80536Medicare UPIN
ORR133063Medicare PIN