Provider Demographics
NPI:1417156258
Name:GARY D. YAEGER, D.C., INC
Entity type:Organization
Organization Name:GARY D. YAEGER, D.C., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:YAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-947-0188
Mailing Address - Street 1:3100 OAK RD
Mailing Address - Street 2:STE. 120
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7746
Mailing Address - Country:US
Mailing Address - Phone:925-947-0188
Mailing Address - Fax:925-947-0188
Practice Address - Street 1:3100 OAK RD
Practice Address - Street 2:STE. 120
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-7746
Practice Address - Country:US
Practice Address - Phone:925-947-0188
Practice Address - Fax:925-947-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23434261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05350ZMedicare PIN