Provider Demographics
NPI:1316142524
Name:YOCUM CHIROPRACTIC
Entity type:Organization
Organization Name:YOCUM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:YOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-429-9610
Mailing Address - Street 1:309 W BOOT RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1109
Mailing Address - Country:US
Mailing Address - Phone:610-429-9610
Mailing Address - Fax:610-431-4842
Practice Address - Street 1:309 W BOOT RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1109
Practice Address - Country:US
Practice Address - Phone:610-429-9610
Practice Address - Fax:610-431-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006285L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAYO417786Medicare ID - Type UnspecifiedCHIROPRACTOR