Provider Demographics
NPI:1962578963
Name:YODER, KYLE JAY (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JAY
Last Name:YODER
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 1:1144 SONOMA AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4812
Mailing Address - Country:US
Mailing Address - Phone:707-527-7100
Mailing Address - Fax:707-527-7101
Practice Address - Street 1:1144 SONOMA AVE STE 112
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4812
Practice Address - Country:US
Practice Address - Phone:707-527-7100
Practice Address - Fax:707-527-7101
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20046DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFD248AMedicare UPIN