Provider Demographics
NPI:1316313422
Name:YELVERTON, BRIAN ROBERT (LAC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ROBERT
Last Name:YELVERTON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 E 36TH AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4166
Mailing Address - Country:US
Mailing Address - Phone:907-929-7818
Mailing Address - Fax:
Practice Address - Street 1:751 E 36TH AVE
Practice Address - Street 2:STE. 102
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4166
Practice Address - Country:US
Practice Address - Phone:907-929-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101947171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist