Provider Demographics
NPI:1194734657
Name:YEAGER, MARK R (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:YEAGER
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 1:100 N TRYON ST
Mailing Address - Street 2:STE 165
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3264
Mailing Address - Country:US
Mailing Address - Phone:704-333-0550
Mailing Address - Fax:704-333-0988
Practice Address - Street 1:100 N TRYON ST STE 165
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202
Practice Address - Country:US
Practice Address - Phone:704-333-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU77251Medicare UPIN
NC890838XMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER