Provider Demographics
NPI:1568474708
Name:YADANZA, JAMES MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:YADANZA
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 1:11885 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590-1027
Mailing Address - Country:US
Mailing Address - Phone:315-594-9400
Mailing Address - Fax:315-594-9613
Practice Address - Street 1:11885 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-1027
Practice Address - Country:US
Practice Address - Phone:315-594-9400
Practice Address - Fax:315-594-9613
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0009601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110363ANOtherPREFERRED CARE PROVIDER N
NY7087371OtherAETNA PROVIDER NUMBER
NYBB9972Medicare ID - Type Unspecified