Provider Demographics
NPI:1326224759
Name:YODER CHIROPRACTIC INC
Entity type:Organization
Organization Name:YODER CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-751-5083
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8013Medicare PIN